1-5-610. Short forms. The following short-form certificates of notarial acts are sufficient for the purposes indicated if they are completed with the information required by 1-5-609(1) through (4):
(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)
(Official Stamp)
................................
Printed name and title of officer (if not shown in stamp)
(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 (title or capacity) of or for (name of party on behalf of whom the record was executed).
...............................
(Signature of notarial officer)
(Official stamp)
...............................
Printed name and title of officer (if not shown in stamp)
(3) For a verification on oath or affirmation (jurat):
State of........................
County of......................
This record was signed and sworn to (or affirmed) before me on (date) by (name(s) of individual(s)) ........................
......................
(Signature of notarial officer)
(Official stamp)
...........................
Printed name and title of officer (if not shown in stamp)
(4) For witnessing or attesting a signature:
State of........................
County of........................
The record was signed before me on (date) by (name(s) of individual(s)) ........................
.............................
(Signature of notarial officer)
(Official stamp)
.....................................
Printed name and title of officer (if not shown in stamp)
(5) For a signature witnessing in a representative capacity:
State of........................
County of......................
This record was signed before me on (date) by (name(s) of individual(s)) as (title or capacity) of or for (name of party on behalf of whom the record was executed).
..............................................
(Signature of notarial officer)
(Official Stamp)
...............................
Printed name and title of officer (if not shown in stamp)
(6) For certifying a copy of a tangible record:
State of........................
County of........................
I certify that this is a true and correct copy of (identification of record), an original record in the possession of, or issued by, (custodian or issuer) and made by me on (date).
.......................................
(Signature of notarial officer)
(Official stamp)
..................................
Printed name and title of officer (if not shown in stamp)
(7) For certifying a copy of an electronic record:
State of........................
County of......................
I certify that the foregoing and annexed record entitled (title of record), dated ................., and consisting of ........... (pages or size of file) is a true and correct copy of an electronic record printed directly from the electronic file by me on (date).
.......................................
(Signature of notarial officer)
(Official stamp)
.......................................
Printed name and title of officer (if not shown in stamp)
(8) For certifying a transcript of a deposition or affidavit:
State of........................
County of........................
I hereby certify and state the following:
that I have sworn in the deponent;
that the deposition was taken before me and this is a true and accurate transcription of the testimony;
that I am not a relative, agent, or employee of the deponent or the attorney or counsel of any of the parties;
that I am not an interested party to the matter.
A review of this transcript (was / was not) requested.
Dated this ........................ day of ........................, 20...
.......................................
(Signature of notarial officer)
(Official stamp)
.......................................
Printed name and title of officer (if not shown in stamp)
(9) For a remote notarization or remote online notarization on a tangible or electronic record for a principal located outside the United States:
State of........................
County of......................
This record was (acknowledged) (signed) (signed and sworn to or affirmed) before me by use of communication technology on (date) by (name of principal(s)), who declared that (he) (she) (they) (is) (are) located in (place where principal(s) was/were physically located at the time of notarial act) and that this record is part of or pertains to a matter that is to be filed with or is before a court, governmental entity, or other entity located in the United States or involves property located in, or a transaction substantially connected with, the United States.
.......................................
(Signature of notarial officer)
(Official stamp)
.......................................
Printed name and title of officer (if not shown in stamp)
(10) For a remote notarization or remote online notarization on a tangible or electronic record for a principal located in or outside this state but within the United States:
State of........................
County of......................
This record was (acknowledged) (signed) (signed and sworn to or affirmed) before me by use of communication technology on (date) by (name of principal(s)), who declared that (he) (she) (they) (is) (are) located in (place within the United States where principal(s) was/were physically located at the time of notarial act).
.......................................
(Signature of notarial officer)
(Official stamp)
.......................................
Printed name and title of officer (if not shown in stamp)
(11) For a certification of fact or event:
State of........................
County of......................
I certify that I have confirmed that (information that is being verified) is true and correct based on a review of (the source of the information) made by me on (date).
.......................................
(Signature of notarial officer)
(Official stamp)
.......................................
Printed name and title of officer (if not shown in stamp)
(12) For certification of life:
State of........................
County of......................
I certify that (name of individual) is alive and appeared physically before me at (location where individual appeared) on (date) at (time a.m. or p.m.).
.......................................
(Signature of notarial officer)
(Official stamp)
.......................................
Printed name and title of officer (if not shown in stamp)
(13) For certification of photograph:
State of........................
County of......................
I certify that the attached photograph is an accurate representation of (name of individual or item) based on (how subject was confirmed) on (date).
.......................................
(Signature of notarial officer)
(Official stamp)
.......................................
Printed name and title of officer (if not shown in stamp)"
History: En. Sec. 10, Ch. 192, L. 1993; amd. Sec. 12, Ch. 161, L. 2001; amd. Sec. 3, Ch. 12, L. 2003; amd. Sec. 5, Ch. 319, L. 2009; amd. Sec. 10, Ch. 391, L. 2015; amd. Sec. 2, Ch. 275, L. 2017; amd. Sec. 4, Ch. 123, L. 2019.