______________________________________________________________________________

(1) For an acknowledgment in an individual capacity:

State of _________

County of _________

This record was acknowledged before me on (date) ______by (name(s) of individual(s))_________.

Signature of notarial officer: ____________

Stamp (if required):

Title of office: ____________

My commission expires: _________

(2) For an acknowledgment in a representative capacity:

State of _________

County of _________

This record was acknowledged before me on (date) ______by (name(s) of individual(s)) _________as (type of authority, such as officer or trustee) _________of (name of party on behalf of whom record was executed)____________.

Signature of notarial officer: ____________

Stamp (if required):

Title of office: ____________

My commission expires: _________

(3) For a verification on oath or affirmation:

State of _________

County of _________

Signed and sworn to (or affirmed) before me on (date) ______by (name(s) of individual(s)) making statement_________.

Signature of notarial officer:

Stamp (if required):

Title of office: ____________

My commission expires: _________

(4) For witnessing or attesting a signature:

State of _________

County of _________

Signed (or attested) before me on (date) ______by (name(s) of individual(s))_________.

Signature of notarial officer: ____________

Stamp (if required):

Title of office: ____________

My commission expires: _________

(5) For certifying or attesting a copy of a record:

State of _________

County of _________

I certify (or attest) that this is a true and correct copy of a record in the possession of____________.

Dated ______

Signature of notarial officer: ____________

Stamp (if required):

Title of office: ____________

My commission expires: _________

______________________________________________________________________________ [2013 c.219 §15]