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Custodian of Records Affidavit - Illinois

Illinois · 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. Authenticate business records for production in a Illinois proceeding.

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Who this form is for

  • Authenticate business records for production in a Illinois proceeding.
  • 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 this packet and check the receiving agency's required form.
  • Gather the names, dates and supporting records requested in the document.
  • Bring acceptable identification for any required notarial act.

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.
  3. Attach the affidavit to the records it describes.

Related Illinois forms

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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