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NOTICE .
OFFENDER NOTARY PUBLIC SERVICE
Under both Federa| law (28 U.S.C § l746) and State law (V.T.C.A. Civil Practice & Remedies
Code, §l32.00l-l32.003), 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 provided '
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An example of an unsworn declaration pursuant 10 State law is as follows.'
"My name is G(I)\OO`` F)\\ "'_' GlFClDV\C/\ my date ofbirtli is 9 a | 5 &Q ,
(Firsr) (Middie) (Lasr)
and my inmate identifying number, is §\_/_\H EMQ‘Z’L n . l am presently incarcerated in
D<\\ Q.LA \h¢\-\)( ~¢ 110 .Q/§\ in \bL)oQ QQ,\J\C
`` Executed on the _ day of
`` , (Corrections unit name) _ (Cit}’)
\»LC)A'\\’U\ ‘Y€¥£LS di \03\0,(? . l declare under penalty of
(County) (State) (Zip Code)
perjury that the foregoing is true and correct.
Executed on the "\»\ir\da)/ of MM\€, ' , 2
a TIre``)``nw
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An example of an unsworn declaration pursuant to Federal law is as follows:
(insert offender name and TDCJ number), being
(insert TDCJ unit name), in
County, Texas, declare under penalty of perjury that the foregoing is true
l
presently incarcerated in
and correct.
, 20
' (Offender Signature)
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NOTICE
NOTARY PUBLIC SERVICE DENIAL
Regarding your request for Notary Public service, insufficient justification was provided
necessitating Notary Public service, However, you may proceed with an Unsworn Declaration.
t;\>»s\\>»w\e\i_jl»ma§r§:g“‘. i§ mr
(Signature - Notary) (Date)
l\ ioO\§ d\Q/“T\'QO\ Y\bx``°\di°‘\/“u’\ °‘c M``UJ€/ O\\'> (‘M\v\£/vv'§&, @'\/iw/\
lhsf"\. l - - l ' ym@l