An unsworn declaration may be used in place of an affidavit. See section 8.58 of the practice notes and form 8-27.
|
Include the following notice if a minor is named in the caption or if the affidavit contains other unredacted sensitive data. See § 6 of the Introduction in volume 1 of this manual concerning protection of sensitive data in filed documents. |
NOTICE: THIS DOCUMENT
CONTAINS SENSITIVE DATA
[Caption. See § 3 of the Introduction in volume 1 of this manual.]
Affidavit Concerning Cost and Necessity of Services
[Name] appeared in person before me today and stated on oath:
“My name is [name of affiant]. I am above the age of eighteen years, and I am fully competent to make this affidavit. The facts stated in this affidavit are within my personal knowledge and are true and correct.
|
Select one of the following. |
“On [date] I provided a service to [name of recipient]. An itemized statement of the service and the charge for the service is attached to this affidavit and is a part of this affidavit.
|
Or |
“I am the person in charge of records of [name of service provider]. Attached to this affidavit are records that provide an itemized statement of the service and the charge for the service that [name of service provider] provided to [name of recipient] on [date]. The attached records are a part of this affidavit.
“I keep the attached records in the regular course of business. The information contained in the records was transmitted to me in the regular course of business by [name of service provider] or an employee or representative of [name of service provider] who had personal knowledge of the information. The records were made at or near the time or reasonably soon after the time that the service was provided. The records are the original or an exact duplicate of the original.
|
Continue with the following. |
“The service [I] provided was necessary and the amount [that I] charged for the service was reasonable at the time and place that the service was provided.”
Affiant
SIGNED under oath before me on ______________________________.
Notary Public, State of Texas
Certificate of Service
I certify that a true copy of this [document/[title of document]] was served in accordance with rule 21a of the Texas Rules of Civil Procedure on the following on [date]:
[Name of attorney of record or party to be served] by [electronic filing manager/e-mail at [e-mail address]/fax at [fax number]/personal delivery at [address]/commercial delivery service at [address]/certified mail at [address]/first-class mail at [address]]. [Repeat for each attorney of record or party to be served.]
[Name]
Attorney for [Petitioner/Respondent]