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<br />~'~ h <br />OATH OF OFFICE <br />I, do solemnly swear <br />(or affirm), that I will faithfully execute the duties of the office of <br />health Authority of and will to the best <br />(City, County, or District) <br />of my ability preserve, protect, and defend the Constitution and laws <br />of the United States and of this State; and I furthermore solemnly <br />swear (or affirm), that I have not directly nor indirectly paid, offered, <br />or promised to pay, contributed, nor promised to contribute any <br />money, or valuable thing, or promised any public office or employ- <br />ment, as a reward to secure my appointment. So help me God. <br />Health Authority <br />Mailing Address Zip <br />(Area Code) Phone Number <br />SWORIy TO and Subscribed before me this <br />day of <br />,19 <br />lyotary Public, County, Texas. <br />~-Certification of Appointment ~~ <br />I <br />do hereby <br />certify that on day of 19 , <br />a physician licensed <br />by the Texas Board of Medical Examiners, was duly appointed the <br />fIealth Authority of Texas, <br />(City, County, or District) <br />for the term to begin on 19 and end on <br />19 ,unless said authority is removed by law. <br />Signed <br />Title <br />