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ATC-060 (Rev. 7) Attachment 2

NOTICE OFFENDER NOTARY PUBLIC SERVICE Under both Federal law (28 U.S.C § 1746) and State law (V.T.C.A. Civil Practice &Remedies Code, §132.001-132.003), 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.

In arequest for Notary Public service, each offender must explain why an Unsworn Declaration is insufficient before Notary Public service will be provided.

An example ofan unsworn declaration pursuant to State law is asfollows: "My name is§&s\o vl l^ C0-^OWV my date ofbirth is \/4 J^ , (First) (Middle) (Last) and my inmate identifying number, is xlH ZM^L • Iam presently incarcerated in (CorrectionS/Unit name) (City) Uc£cY0A<X -vG^aS T<U^T • Ideclare under penalty of (County) " (State) (Zip Code) perjury that the foregoing istrueand correct.

Executed on the _vl_dayJ of Of\Q.QoV •20^.^kK | ^^M^ " (Offender Signature) **************************************************** An example ofan unsworn declaration pursuant to Federal law is asfollows: I (insert offender name and TDCJ number), being presently incarcerated in (insert TDCJ unit name), in County, Texas, declare under penalty ofperjury that the foregoing is true and correct. it

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. However, you may proceed with an Unsworn Declaration.

(Signature - Notary) (Date) -<<SVx\ov£ V- Qj^^^^AV A<r. 7014 1B5D ODD! 2045 41L7 zvov Y^. i$j\ £.

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