Custodian of Records Affidavit - North Carolina

Download Custodian of Records Affidavit - North Carolina PDF

North Carolina · 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 packet and check the receiving agency's required form.
Gather the names, dates and supporting records requested in the document.
Review the packet's signing, identification and witness instructions.

How to complete it

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

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