3. The affidavit required by subsection 2 must be in substantially the following form: CERTIFICATE OF CUSTODIAN OF RECORDS
State of Nevada | } | |
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County of................................................ | } | |
NOW COMES ................................, who after first being duly sworn deposes and says:
1. That the deponent is the ................ (position or title) ................ of ............... (name of employer) ................ and in his or her capacity as .............. (position or title) ................ is a custodian of the records of ............. (name of employer) ................2. That ................. (name of employer) ................ is licensed or registered to do business as a ................... in the State of ................3. That on the ....... day of the month of ....... of the year ......., the deponent was served with a subpoena in connection with the above-entitled cause, calling for the production of records pertaining to ..........................................................................................................................................
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4. That the deponent has examined the original of those records and has made or caused to be made a true and exact copy of them and that the reproduction of them attached hereto is true and complete.5. That the original of those records was made at or near the time of the act, event, condition, opinion or diagnosis recited therein by or from information transmitted by a person with knowledge, in the course of a regularly conducted activity of the deponent or ............ (name of employer) ................ ...............................................................................
Subscribed and sworn to before me, a Notary Public, on this ....... day of the month of ....... of the year .......
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Notary Public ................ County, Nevada
My appointment expires:..............................................................................................