41-265. Short form certificates
(Eff. 7/1/22)
The following short form certificates of notarial acts are sufficient for the purposes indicated, if completed with the information required by section 41-264, subsections A and B:
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
(_____________________________________)
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
(_______________________________________)
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
(_________________________________________)
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
(__________________________________________)
Title of office
(My commission expires: ___________________)
5. For certifying a copy of a record:
State of ________________________________________
(County) of _____________________________________
I certify that this is a true and correct copy of a record in the possession of _________________________________.
Dated _______________________________
_____________________________________
Signature of notarial officer
Stamp
(____________________________________)
Title of office
(My commission expires: _____________)
6. For certifying a tangible copy of an electronic record:
State of _______________________________________________
(County) of ____________________________________________ I certify that the foregoing copy of a record (entitled ________) (dated _______) and containing ________ pages is an accurate copy of an electronic record.
Dated ____________________________________
__________________________________________
Signature of notarial officer
Stamp
(_________________________________________)
Title of office
(My commission expires: __________________)