Jason Key

 
 Cause No. 29719365332 
 Jason Key 
 搂 
 IN THE DISTRICT COURT OF 
 搂 
 搂 
 vs. 
 搂 
 TARRANT COUNTY, TEXAS 
 DOLLAR GENERAL CORPORATION, 
 DOLGENCORP OF TEXAS, INC. 
 搂 
 352ND JUDICIAL DISTRICT 
 AFFIDAVIT 
 RECORDS PERTAINING TO: Jason Key 
 DATE OF SERVICE: 06/04/17 to present 
 BEFORE 
 ME, 
 the 
 undersigned 
 authority 
 personally 
 appeared 
 Spencer Derrick 
 who, being by me duly sworn, deposed as follows:
 the record was made at or near the time of the act, event or condition recorded or reasonably soon thereafter. 
 1. Total amount of medical or health care expenses from your office billed for CLEMIS J. JAMISON 
 for 06/04/17 to present $ 8,260.00 
 2. Total amount of medical or health care expenses that Jason Key has actually paid for 
 06/04/17 to present which equals $ 
 0 
 The records attached copies of the microfiche on which 
 the image of the original documents have been transferred and nothing has been removed from the original file before 
 making these copies. 
 THE RECORDS ATTACHED HERETO ARE TRUE, CORRECT AND COMPLETE. FURTHER AFFIANT 
 SAITH NOT 
 Spencer arrick 
 Sherrie L. Galvan 
 SIGNATURE OF NOTARY PUBLIC IN AND FOR THE STATE OF TX 
 My Commission expires 
 01/10/14 
 Order No. 24504.77
 FLAUG 
 Sherrie L Galvan 
 My Commission Expires 
 9/28/2028 
 Notary ID 
 160195599
