Custodian of Records Affidavit - California

California · Fillable PDF · Free

Hospitals, clinics, and businesses use this sworn affidavit when producing records for an insurance claim or lawsuit, to confirm the copies are true, complete, and kept in the regular course of business. Hospitals, clinics, and businesses use this sworn affidavit when producing records for an insurance claim or lawsuit, to confirm the copies are true, complete, and kept in the regular course of business.

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Who this form is for

  • Hospitals, clinics, and businesses use this sworn affidavit when producing records for an insurance claim or lawsuit, to confirm the copies are true, complete, and kept in the regular course of business.

What you'll need

  • Read the original packet's instructions and check the receiving agency's requirements.
  • Have the requested document details and acceptable identification ready.

How to complete it

  1. Fill in the request (Page 1) Identify the records, dates, and number of pages produced, or check that no records were found.
  2. Swear before a notary Sign under oath before the notary with a current, government-issued photo ID.

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These forms are a free convenience, not legal advice. First Choice Mobile Notary & Apostille is not a law firm. Consult an attorney licensed in the relevant state for legal questions.

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