Are you a Texas resident looking to certify a document in accordance with the laws of the state? If so, you may need to complete and submit Texas Form 115. This form, also known as an Affidavit for Execution Outside of State Under Certain Conditions, is often used when certifying documents such as wills, trusts, or power of attorney forms without physically appearing before a notary public within the state. In this blog post, we'll cover what exactly Texas Form 115 is and how it works in detail - from its legal definitions to filing requirements - so that everything comes together seamlessly on your end.
| Question | Answer |
|---|---|
| Form Name | Texas Form Nar 115 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | designee, Admin, certifies, EMS |
Modification of
under
Texas Controlled Substances Act
EMS Registration Information
___________________ |
___________________ |
______________________ |
DPS Number |
DEA Number |
DSHS Board License Number |
Old Information(Medical Director)
______________________________________________________________________________________
Name (Last, First, Middle) |
Degree |
TX Medical Board # Personal DPS Number |
_________________________________________________________________ |
||
EMS Business Address |
|
|
_________________________________________________________________
_________________________________________________________________
City, State, Zip
New Information(Medical Director)
______________________________________________________________________________________
Name (Last, First, Middle)Degree TX Medical Board # Personal DPS Number
_________________________________________________________________
EMS Business Address (Cannot accept a PO Box number only)
_________________________________________________________________
_________________________________________________________________
City, State, Zip
Drug Schedules (Check all applicable) (2) Schedule II
(2N) Schedule
(3) Schedule III
(3N) Schedule
(4) Schedule IV
(5) Schedule V
Signature
__________________________ |
( |
)_____________ |
_____________________ |
Signature of Medical Director |
Phone Number |
Date |
|
Signature |
|
|
|
__________________________ |
( |
)_____________ |
_____________________ |
Signature of EMS Admin. |
Phone Number |
Date |
|
Notice: Signature of applicants certifies that the above information is current and correct. Signature of applicant further grants the director or his designee the right to inspect controlled premises or records to be kept by the Texas Controlled Substances Act of 1973.
Return to: Controlled Substances Registration