THE STATE OF TEXAS§
COUNTY OF §
BEFORE ME, the undersigned authority, personally appeared , who, being by me duly sworn, deposed as follows:
“My name is . I am of sound mind, capable of making this Affidavit, and personally acquainted with the facts herein stated:
“I am the custodian of the records of . Attached hereto are pages of records from . These said pages of records are kept by ______________ in the regular course of business, and it was the regular course of business of _____________for an employee or representative of , with knowledge of the act, event, condition, opinion, or diagnosis, recorded to make the record or to transmit information thereof to be included in such record; and the record was made at or near the time or reasonably soon thereafter. The records attached hereto are the original or exact duplicates of the original.
“The claim evidenced by the attached documents is within the knowledge of affiant, just and true, it is due and all just and lawful offsets, payments and credits have been allowed.”
SWORN TO AND SUBSCRIBED BEFORE ME on this the ___ day of __________________, ______, to certify which witness my hand and seal of office.
NOTARY PUBLIC, STATE OF TEXAS