Financial Affidavit In Support Of Application {17A-2}

17A-2, FINANCIAL AFFIDAVIT IN SUPPORT OF APPLICATION, All items of information in this application are mandatory. Failure to provide any of the requested information will result in the application being rejected as incomplete. The information will be used to determine qualifications for registration under the California Pharmacy Law. The official responsible for information maintenance is the executive officer, at the address listed above. The information may be transferred to another governmental agency such as a law enforcement agency if necessary, for it to perform its duties. Each individual has the right to review the files or records maintained on them by our agency, unless the records are identified as confidential information and exempted by section 1798.3 of the Civil Code. www.FormsWorkflow.com