Examination Declaration - Custodian
DECLARATION OF CUSTODIAN FOR EXAMINEE
I, __________________________________, of ___________________________________________, hereby declare that
_________________________________ has been in my presence and custody from the time of ____________ to _____________ on _____________________.
During that time said examinee did not have contact with anyone involved in the _________________________ examination and did not communicate with any other person about the contents of the examination.
I have read the foregoing and hereby declare under penalty of perjury, that the foregoing is true and correct.
Executed on _____________, at _______________________, __:__
(Date) (Location) (Time)