COMMONWEALTH OF MASSACHUSETTS

SUFFOLK COUNTY	BOARD OF REGISTRATION 
								IN PHARMACY

In the Matter of	
Theresa Crawford
Reg. No. PT 6532  (exp. 04/21/2013)

	  Docket No. 2011-0135

VOLUNTARY SURRENDER STATEMENT

I, Theresa Crawford (Reg. No. PT 6532), do voluntarily surrender my license to practice as a pharmacy technician in the Commonwealth of Massachusetts to the Board of Registration in Pharmacy (Board) and do state to the Board:

1.   I hereby voluntarily surrender my license to practice as a pharmacy technician in the 
     Commonwealth of Massachusetts (Reg. No, PT 6532) together with any right to renew 
      my license, to the Board, effective as of the date of my signature hereto;
2.   I acknowledge and agree that I have surrendered my license to the Board in resolution of
Complaint Docket No. 2011-0135 (Complaint);
3.   I understand that surrender of my license is considered to be a reportable disciplinary act which deprives me of all privileges of registration; that my surrender is not subject to reconsideration or judicial review; and that I am waiving my right to a hearing pursuant to G.L. c. 30A regarding the Complaint;
4.   I will surrender any current license or registration to practice as a pharmacy technician issued by any other jurisdiction effective as of the date of my signature hereto and will not apply or attempt to gain licensure as a pharmacy technician or to renew any pham1acy technician license previously issued by any other jurisdiction; and
5.   I acknowledge that I have been provided the opportunity to consult legal counsel 
          regarding my decision to execute this statement and surrender my license and that my 
         decision to execute this statement and surrender my license was made of my own free will

SIGNED UNDER THE PAINS AND PENALTIES OF PERJURY this 13th day of June, 2011.

Theresa Crawford
     [redacted]