Free Affidavit Certifying Completion of Mandated Education - West Virginia

IN THE CIRCUIT COURT OF _______________ COUNTY, WEST VIRGINIA
For Clerk's Use Only IN RE: ______________________________________________, AN ALLEGED PROTECTED PERSON DATE FILED: _____________________________________ CASE NUMBER ___________ - G - __________

AFFIDAVIT CERTIFYING COMPLETION OF MANDATED EDUCATION
[West Virginia Code: § 44A-1-10(b).]

STATE OF ___________________________________________, COUNTY OF _________________________________________, to wit:

I, ________________________________, the recommended conservator and/or guardian in the foregoing matter, hereby certify that I have completed the mandatory educational training required by West Virginia Code: § 44A-1-10(b), and that such education consisted of [check applicable form of the materials studied]: __________ __________ __________ Written materials Recorded information, whether audio, visual or both A combination of both written materials and recorded information

I further certify that the foregoing educational training was completed by me on [insert the date you completed the mandatory education] ____________________________________________ .

Given under my hand this ________ day of _______________________, 20____.

_________________________________________________________ SIGNATURE The foregoing affidavit was taken, subscribed and sworn or affirmed before me by the said

____________________________________, in the foregoing action, in my said county and state on this, the _____ day of _____________________, 20 _____. Given under my hand and NOTARIAL SEAL. [AFFIX NOTARIAL SEAL] _________________________________________________________ NOTARY PUBLIC My Commission Expires:___________________________________.

SCA-CG 906A / 6-00