Certificate of Authenticity regarding Microfilm or other Photographic Reproduction of Public Records by pellcity27

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This form is a certificate of authenticity made by the lawful custodian of certain microfilm or other photographic reproductions of public records.

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									                    Certificate of Authenticity regarding Microfilm
               or other Photographic Reproduction of Public Records

State of _________________
County of ___________________

(Name of Affiant) of (street address, city, county, state, zip) hereby certifies to the
following in connection with the hereinafter described (e.g., microfilm) reproduction of
(description of records reproduced):

1.     I am the official and lawful custodian of the following public records: (description
of records reproduced)

2.     Said records are preserved at (street address, city, county, state, zip code) in the
following form: (e.g., microfilm)

3.      The reason and authorization for the foregoing (e.g., microfilm reproduction) is
as follows: (e.g., st
								
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