STATE OF TEXAS				§
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COUNTY OF __________			§

BUSINESS RECORDS AFFIDAVIT

	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 the ________________.  Attached hereto are _____ pages of records from the _____________________.  The said _____ pages of records are kept by the in the regular course of business, and it was the regular course of business of the _____________________________ for an employee or representative of the   _________________, 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.

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{Signature of Affiant}

SWORN AND SUBSCRIBED TO before me on __________________________, 200___.

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Notary Public in and for the State of Texas