Self-Represented Litigant Certification Form
By signing this form, I certify that, to the best of my knowledge, information, and
belief, and based on my reasonable review of the document's
contents, the attached
filing complies with the certification requirements in the Temporary Rule for Filing in a
District Court by a Self-Represented Litigant as follows:
(a) I have signed the attached filing and provided my name, address, email address (if
available), telephone number, and fax number (if available); and
(b) The attached filing contains no personally identifiable information (PII) or meets
an exception in the Temporary Rule for Filing in a District Court by a Self-
Represented Litigant because the filing (check box that applies):
contains no PII (if this box is checked, do not check any other boxes); or
requests that this document be sealed under the Temporary Rule for
Filing in a District Court by a Self-Represented Litigant for the
following reason (check box that applies):
a pre-existing order was entered by the court on ________ that seals
this document;
this document asks the court to issue an order that seals the
following document: [include general description of document
contents without including PII.]
_____________________________; or
this document asks the court to seal the following document already
filed in the case: [describe the document already on file so that the
clerk can identify it without using PII]
_______________________________________________.
Date: _________________ Signature:
Name o
f Party:
OJA 218
