Individual Financial Affidavit {17A-26} | Pdf Fpdf Docx | California

 California   Statewide   Board Of Pharmacy 
Individual Financial Affidavit {17A-26} | Pdf Fpdf Docx | California

Last updated: 12/10/2024

Individual Financial Affidavit {17A-26}

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Description

17A-26 - INDIVIDUAL FINANCIAL AFFIDAVIT. This form is used by the California State Board of Pharmacy to verify financial contributions and funding sources for a pharmacy license application. It gathers details about contributions such as cash, loans, labor, or expertise, sources of funds like savings, property sales, gifts, or inheritances, and requires documentation such as bank statements or loan agreements. It also collects employment history and information about any disciplinary actions on professional licenses. The form includes a certification of accuracy with penalties for falsification. www.FormsWorkflow.com

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