I, _________________________ hereby certify to the following in connection with the foregoing (microfilms) (photographic reproductions):

That I am the official and lawful custodian of the records microfilmed or photographically reproduced and preserved in _________________________ (agency) as ______________________________ identified and described as follows:

That the reason and authorization for this reproduction is as follows:

That certification is herein made pursuant to Section 12276 of the Government Code.

That these (microfilms) (photographic reproductions) of the above-described records were taken under my direction and control on ____________________, 20 ___ and that they are a complete, true, and correct copy thereof.

That the microfilming or other photographic processes were accomplished in a manner and on film which meets with the minimum standards or guidelines, or both, as recommended by the American National Standards Institute or the Association for Information and Image Management, and as adopted by the Secretary of State, for recording of permanent records or nonpermanent records.

Disposition of records reproduced:

( ) To be destroyed

( ) To be deposited in the State Records Center (Department of General Services)

( ) To be preserved in the State Archives (Secretary of State)

( ) To be retained by the agency ____________________ (agency)

( ) Other disposition

______________________________ (Describe fully)

That this certificate was made at the time of the taking of this (microfilm) (photographic reproduction).