47-43.4. Officer's certificate upon proof of instrument by proof of signature of subscribing witness.
When the execution of an instrument is proved by proof of the signature of a subscribing witness as provided by G.S. 47-12.1, the certificate required by G.S. 47-13.1 shall be in substantially the following form:
| STATE OF________________________________________ |
(Name of state)
| _________________________________________ COUNTY |
I, ____________________________, a ______________________________________
| (Name of officer taking proof) | (Official title of officer taking proof) | |
| of ___________________ COUNTY, _______________________________, certify that | ||
| (Name of state) | ||
| ____________________________________ personally appeared before me this day, and | ||
| (Name of person familiar with | ||
| handwriting of subscribing witness) | ||
| being duly sworn, stated that he knows the handwriting of ________________________, | ||
| (Name of subscribing witness) | ||
| and that the signature of __________________________ as a subscribing witness to the | ||
| (Name of subscribing witness) | ||
| foregoing instrument is the signature of _______________________________________ | ||
| (Name of subscribing witness) |
WITNESS my hand and official seal, this the ____ day of ______________, ________
| (Month) | (Year) | ||
| _________________________________________________ | |||
| (Signature of officer taking proof) | |||
| _________________________________________________ | |||
| (Official title of officer taking proof) |
My commission expires _________________________________________________
| (Date of expiration of officer's commission) |