Form of certificate

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    ** IN EFFECT UNTIL OCTOBER 1, 2020 PER CHAPTER 407 OF 2019 **

    An officer taking the acknowledgment shall endorse the acknowledgment or attach to the acknowledgment a certificate substantially in one of the following forms:

    (a)    State of ..... County of .....

    On this the ..... day of ....., 20 ....., before me, ....., the undersigned officer, personally appeared ....., known to me (or satisfactorily proven) to be the person whose name ...... subscribed to the within instrument and acknowledged that ....... executed the same for the purposes therein contained.

    In witness whereof I hereunto set my hand and official seal.

    ...............................................................

    ...............................................................

    Title of officer.

    (b)    State of ..... County of .....

    On this the ..... day of ....., 20 ....., before me, ....., the undersigned officer, personally appeared ....., who acknowledged himself to be the ..... of ....., a corporation, and that he, as such ....., being authorized so to do, executed the foregoing instrument for the purposes therein contained, by signing the name of the corporation by himself as ..................................... .

    In witness whereof I hereunto set my hand and official seal.

    ...............................................................

    ...............................................................

    Title of officer.

    (c)    State of ..... County of .....

    On this the ..... day of ....., 20 ....., before me, ....., the undersigned officer, personally appeared ....., known to me (or satisfactorily proven) to be the person whose name is subscribed as attorney in fact for ....., and acknowledged that he executed the same as the act of his principal for the purposes therein contained.

    In witness whereof I hereunto set my hand and official seal.

    ...............................................................

    ...............................................................

    Title of officer.

    (d)    State of ..... County of .....

    On this the ..... day of ....., 20 ....., before me, ....., the undersigned officer, personally appeared ....., of the State (county or city as the case may be) of ....., known to me (or satisfactorily proven) to be the person described in the foregoing instrument, and acknowledged that he executed the same in the capacity therein stated and for the purposes therein contained.

    In witness whereof I hereunto set my hand and official seal.

    ...............................................................

    ...............................................................

    Title of officer.


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