RS 552 - Form of certificate of acknowledgment
Every certificate of acknowledgment, made without the United States, shall contain the name or names of the person or persons making the acknowledgment, the date when and the place where made, a statement of the fact that the person or persons making the acknowledgment knew the contents of the instrument, and acknowledged it to be his, her or their act; the certificate shall also contain the name of the person before whom made, his official title, and be sealed with his official seal and may be substantially in the following form:
. . . . . . . . . . . . . . . (name of country).
. . . . . . . . . . (name of city, province or other political subdivision).
Before the undersigned . . . . . . . . . . (naming the officer and designating his official title) duly commissioned (or appointed) and qualified, this day personally appeared at the place above named . . . . . . . . . . . . . . . . . . . . (naming the person or pesons acknowledging) who declared that he (she or they) knew the contents of the foregoing instrument, and acknowledged it to be his (her or their) act.
Witness my hand and official seal this . . . . . day of . . . . . . . . . . . . 19 . .
. . . . . . . . . . . . . . . . . . (name of officer).
(seal)
. . . . . . . . . . . . . . . . . . . (official title)
When the seal affixed shall contain the names or the official style of the officer, any error in stating, or failure to state otherwise the name or the official style of the officer, shall not render the certificate defective.