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Attachment 2
NOTICE .
g OFFENDER NOTARY PUBLIC SERVICE
Under both Federal law (28 U.S.C § 1746) and State law (V.T.C.A. Civil Practice & Remedies
Code, §l32.00]-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 Uns``worn Declaration is
insufficient before Notary Public service will be provided ``
**************************#************$**************************************
An example af an unsworn declaration pursuant lo State law is as follows:
"My name is C-’ia/\DY\ F}`` _" ercihnq my date ofbirth is 9 1 l .S'&[Z ,
(First) (M iddle) (Last)
and my inmate identifying number, is \Y_\B\_'\ig'?¢'l_/ . l am presently incarcerated in
D<\\ Q.L€)\ \x¢\.\‘\’ ~< T‘O.C,§ in \bLuC& QGX;\C
`` . (Corrections unit name) _ (City)
\>¢\C\\'\\’U\ ’\'€XCLS fl \03 l£'? . l declare under penalty of
(County) (State) (Zip Code)
perjury that the foregoing is true and correct.
Executed on the l'\-“r\day of S\M\€/ ' , 2
*****************$*****#**********************#******** ********#$#***********
An example of an unsworn declaration pursuan/ to Federal law is as follows:
(insert offender name and TDCJ number), being
(insert TDCJ unit name), in
County, Texas, declare under penalty of perjury that the foregoing is true
l
presently incarcerated in
and correct.
b Executed on the , day of ' , 20 .
`` (Offender Signature)
*****************$****************************************************¥***#***
NOTICE
NOTARY PUBLIC SERVICE DENIAL
/ Regarding your request for Notary Public service, insufficient justification 'was provided
necessitating Notary Public service. l-lowever, you may proceed with an Unsworn Declaration.
l\>»~s~\z\we\i_``l»ma“brssgi\\ im ms
(Signature - Notary) (Date)
k .“)0\5 ()\g,¢"\~ago\ no§r\’\(i?,O\i/vua off M\LS~Q O\o C\/\…AKJ @1/‘\\/\¢/\
L ‘ l l”f’