General Custodian Affidavit Form

GENERAL CUSTODIAN AFFIDAVIT FORM

This General Custodian Affidavit (the Affidavit) is made as of the effective date set forth below by Custodian Name: in the capacity of Custodian Title: of Custodian Organization: , whose business address is . Requesting Party Name: requests certification and delivery of certain records described herein. Effective Date: .

RECITALS

WHEREAS, Custodian maintains possession, custody, and control of certain business records and documents created and maintained in the ordinary course of business (the Records); and

WHEREAS, Requesting Party requires certified copies, authenticated originals, or a sworn statement concerning the Records for purposes of legal, regulatory, administrative, or transactional matters; and

WHEREAS, Custodian has the authority to provide sworn certification of the Records and to attest to the authenticity, maintenance, and chain of custody of such Records.

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the parties agree as follows:

1. DEFINITIONS

For purposes of this Affidavit: "Custodian" means the person executing this Affidavit in the capacity stated above. "Records" means the documents, electronic files, entries, or other materials described in Section 3 and maintained by Custodian in the ordinary course of business. "Certified Copies" means copies of original Records accompanied by this sworn statement attesting to authenticity.

2. AUTHORITY AND CUSTODY

Custodian affirms that Custodian is duly authorized to act on behalf of the Custodian Organization with respect to the Records and that Custodian has actual custody and control of the Records described herein. Custodian further represents that the Records have been created, maintained and stored in the normal course of business, and that the Records are contemporaneous and reliable evidence of the matters to which they pertain.

3. DESCRIPTION OF RECORDS

The Records subject to this Affidavit consist of the following categories and specific items. If additional space is required, attach an exhibit labeled Exhibit A and initial below:

Records attached as Exhibit A: Yes

4. CERTIFICATION OF AUTHENTICITY

Custodian swears and affirms under penalty of perjury that the copies of the Records provided herewith are true, correct and complete copies of the original Records in Custodian's possession, custody, or control. Custodian further attests that, to the best of Custodian's knowledge, the Records were made at or near the time of the occurrence of the matters recorded, by or from information transmitted by a person with knowledge of those matters, and were kept in the ordinary course of business.

5. AUTHENTICATION AND HEARSAY EXCEPTION

This Affidavit supplies the foundation and authentication necessary for admission of the Records as business records under applicable evidentiary rules. Custodian acknowledges that this Affidavit is offered to establish the Records' authenticity and admissibility and that Custodian may be subject to subpoena or other process to provide testimony if required.

6. DELIVERY, RELIANCE, AND LIMITATION OF LIABILITY

Custodian shall deliver the certified copies or originals as requested by Requesting Party upon receipt of any agreed fees and upon reasonable notice. Requesting Party may rely on the truth of this Affidavit for all lawful purposes. EXCEPT FOR THE REPRESENTATIONS SET FORTH IN THIS AFFIDAVIT, CUSTODIAN MAKES NO OTHER EXPRESS OR IMPLIED WARRANTIES AND SHALL NOT BE LIABLE FOR INDIRECT, PUNITIVE, EXEMPLARY OR CONSEQUENTIAL DAMAGES ARISING FROM THE USE OR RELIANCE ON THE RECORDS.

7. FEES AND COSTS

Requesting Party agrees to pay reasonable fees for search, retrieval, reproduction, certification, shipping and handling of the Records as required by Custodian. Any fees advanced by Requesting Party that are not used will be refunded within a commercially reasonable time.

8. INDEMNIFICATION

Requesting Party shall indemnify, defend and hold harmless Custodian and Custodian Organization from and against any and all claims, liabilities, losses, costs and expenses (including reasonable attorneys' fees) arising out of or related to Requesting Party's use, dissemination or publication of the Records, except to the extent arising from Custodian's gross negligence or willful misconduct.

9. NOTICES

All notices, requests or demands required or permitted by this Affidavit must be in writing and delivered to the addresses set forth below (or to such other address as either party may designate by written notice).

10. REPRESENTATIONS; WARRANTY OF AUTHORITY

Each party represents and warrants that it has the full right, power, and authority to enter into and perform this Affidavit. Custodian represents that the person executing this Affidavit is authorized to execute it on behalf of Custodian Organization and to provide the certifications set forth herein.

11. GOVERNING LAW

This Affidavit shall be governed by and construed in accordance with the laws of the state of , without regard to its conflicts of laws principles.

12. AMENDMENTS; WAIVER; SEVERABILITY

No amendment, modification or waiver of any provision of this Affidavit shall be effective unless made in writing and signed by the parties. The failure of any party to enforce any right or provision shall not constitute a waiver of such right or provision. If any provision of this Affidavit is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

13. ENTIRE AGREEMENT; COUNTERPARTS

This Affidavit constitutes the entire agreement between the parties with respect to its subject matter and supersedes all prior negotiations, understandings and agreements, whether written or oral. This Affidavit may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument.

CERTIFICATION AND OATH

I, the undersigned Custodian, declare under penalty of perjury under the laws of the state specified in Section 11 that the foregoing is true and correct, that I am authorized to execute this Affidavit on behalf of Custodian Organization, and that I understand that false statements may subject me to criminal penalties.

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