CERTIFICATION AFFIDAVIT OF COURT REPORTING FIRM
STATE OF _____________________
PARISH OR COUNTY OF ____________________
BEFORE ME, the undersigned authority, duly qualified to take acknowledgments and administer oaths within the state and locality inscribed above, personally appeared
__________________________________________________
("Affiant"), who is representing
_______________________________________________,
a ____________ [state] corporation [or limited liability company or other form of business organization] that is doing business in Louisiana as a court reporting firm as defined by Acts 2014, No. 839 (hereinafter, "Court Reporting Firm"). The physical address of the entity's principal place of business is ______________________ [street and suite number, if any] in ____________________ [city], State of ________________, Zip _______, Telephone: ( ) ________________, Email _________________________.
After being duly sworn, Affiant did attest as follows:
SIGNATURE OF AFFIANT: __________________________
Sworn before me this ______ day of ______, 20___
_________________________________
Notary Public ______________________
Print name:
My commission expires:
Form 10/15 Effective July 1, 2016
Each completed Firm Certification Affidavit in the foregoing form must be filed with the CSR Board by the taking court reporter within 30 days of the date of the deposition.
I, a Louisiana Licensed Court Reporter, as the officer who took the depositions(s), hereby submit this certification affidavit via _____________________ [facsimile/e-mail] within 30 days of the date of the depositions to which this certification applies. I have read and confirmed that the language of the certification affidavit conforms with the form promulgated by the CSR Board. I have listed below or on additional pages, if necessary, the name and contact information for each taking attorney. _________________ ________________ Signature Date __________________ ________________ Printed Name LA CCR NO. Taking Attorney Name: __________________________________ Firm Name: ___________________________________________ Address: _____________________________________________ _____________________________________________ Phone: ___________________ Email: ___________________ |
I, a Louisiana Licensed Court Reporter, hereby submit this certification affidavit via _____________________ [facsimile/email] within 30 days of the date of the depositions to which this certification applies and acknowledge my obligation to maintain the schedule for a minimum of three years. I further certify that I have received the required schedule of all charges and other disclosures from the Court Reporting Firm in connection with this certification.
_______________________________________
Signature Date
________________________________________
Printed Name LA CCR NO.
La. Admin. Code tit. 46, § XXI-1303