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ATC-060 (Rev. 7)
Attachment 2
NOTICE .
7 OFFENDER NOTARY PUBL]C SERVICE
Under both Federal law (28 U.S.C § l746) and State law (V.T.C.A. Civil Pra_ctice & Remedies
Code, §l32.00l-l 32.003), offenders incarcerated in Texas may use an unsworn declaration under
penalty of perjury in place of a written declaration, verification, certification, oath, or affidavit
sworn before a Notary Public.
ln a request for Notary Public service, each offender must explain why an Unsworn Declaration is
insufficient before Notary Public service will be pi'ovided. '
***************************************$**************************************
An example of an unsworn declaration pursuant to State law is as follows.'
"My name is G(X/\vh F)`` _" CO.|'Cl(')V\C\ my date ofbirth is g a l 5 g g ,
(First) (M iddle) (Last)
and my inmate identifying number, is \BH H!g‘z'l_, . l am presently incarcerated in
D<\.\ QJ.A \&(\,\)( -c ``Y:O.C,§ in \bbo€t QQ,€\C
`` , (Corrections unit name) _ (City)
\DLC§¢\'\\’¢\ 'T€_¥JCLS /i w;lé'? . l declare under penalty of
(County) (State) (Zip Code)
perjury that the foregoing is true and correct.
Executed on the i \:\bday of _\g,v\ Q¢ ' , 2
******************************************************* **********************
An example of an unsworn declaration pursuan/ to Federal law is as follows:
(insert offender name and TDCJ number), ibeing
(insert TDCJ unit name), in
County, Texas, declare under penalty of perjury that the foregoing is true
l
presently incarcerated in
and correct.
Executed on the , day of , 20
`` (Offender Signatui'e)
=i==i<=i==i=*****>i=>i=*=i==i<>i<=i=>i<***=i=***#****>i<*>i<**>i<**=i=*********#****=i=****>i=»i=>i=**>i=*>i=*=i<**>i=*'>i=*>i=_>i=**>i=
NOTICE
NOTARY PUBLlC SERVICE DENIAL
insufficient justification vwas provided
Regarding your request for Notary Public service,
d with an Unsworn Declaration.
necessitating Notai'y Public service. l-lowever, you may procee
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