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SAMPLE NOTARY STATEMENTS

Sample Notary Statements for the following forms:

  • Acknowledgments
  • Oaths
  • Depositions
  • Affidavits
  • Certificates
  • Verifications


Acknowledgments

An acknowledgment is a formal declaration before an authorized official such as a notary public by a person who has signed a document, that the document is his or her act. Acknowledgments are governed by the Uniform Acknowledgment Act.

The person acknowledging the document must personally appear before the notary.

In addition, the person must sign the document in the notary’s presence, or acknowledge that the signature on the document is his or her own.

An acknowledgment of any instrument may be made within this state before:

(1) A judge of a court of record;

(2) A clerk, prothonotary or deputy prothonotary or deputy clerk of a court having a seal;

(3) A recorder of deeds or a deputy recorder of deeds;

(4) A notary public;

(5) A District Justice, magistrate or alderman.


Acknowledgments within the United States:

An acknowledgment of any instrument may be made without the state, but within the United States, or territory or insular possession of the United States, or the District of Columbia, and within the jurisdiction of the officer before --

(1) A clerk or deputy clerk of any federal court;

(2) A clerk, prothonotary or deputy prothonotary or deputy clerk of any court of record of any jurisdiction;

(3) A notary public;

(4) A recorder of deeds.

Acknowledgments without the United States:
(1) An ambassador, minister, charge d‘affaires, counselor to or secretary of a legation, consul general, vice-consul, commercial attaché or consular agent of the United States accredited to the country where acknowledgment is made;

(2) A notary public of the country where acknowledgment is made;

(3) A judge or clerk of a court where acknowledgment is made.


SAMPLE ACKNOWLEDGMENTS

By an individual



On this, the______day of __________, 2013, before me a notary public, the undersigned officer, personally appeared Mary Jones, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained.

In witness hereof, I hereunto set my hand and official seal.

___________________________
Notary Public

Statement of venue indicates the state and county in which the notarization occurs. A notary's jurisdiction is co-extensive with the boundaries of the commonwealth. Pennsylvania notaries may not notarize documents outside of the state. The date of the acknowledgment can be later than the date of the instrument but in no instance may the date of the document be later than the date of the acknowledgment

By a corporate officer



On this, the________day of __________, 2013, before me a notary public, the undersigned officer, personally appeared John Smith, who acknowledged himself to be the President of ABC ENTERPRISES, INC, a corporation, and that he as such officer, being authorized to do so, executed the foregoing instrument for the purpose therein contained by signing the name of the corporation by himself as President.

In witness hereof, I hereunto set my hand and official seal.


___________________________
Notary Public

 

By an attorney-in-fact



On this, the____day of __________, 2013, before me a notary public, the undersigned officer, personally appeared Harvey Anyone, known to me (or satisfactorily proven) to be the person whose name is subscribed as attorney in fact for John Smith, and acknowledged that he executed the same as the act of his principal for the purposes therein contained.

In witness hereof, I hereunto set my hand and official seal.


_________________________________
Notary Public

If someone claims to be able to sign for another, a demand to see the power of attorney is required. In real estate matters the power of attorney must be formally acknowledged before a notary public so that it can be recorded along with the real estate deed, deed of trust, mortgage, or other document. A power of attorney can be either witnessed by one or more persons or notarized. Does not require both. Keep in mind that a notary cannot act as both a witness and as a notary on the same document.

 

By a Pennsylvania attorney-at-law pursuant to 42 Pa.C.S.A. 327

Subscribed, sworn to and acknowledged before me by John Jones, known to me (or satisfactorily proven) to be the person described in the foregoing (Instrument or type of document) who acknowledged that he/she executed the same in the capacity therein stated, and for the purposes therein contained, and subscribed and sworn to before me by______________________, the witness, this_______ day of____________, 20__.


______________________________
Adam Smith, Esquire


Member of the Bar of the
Supreme Court of Pennsylvania
I.D. #



On this, the____day of __________, 2013, before me a notary public, the undersigned officer, personally appeared Adam Smith, Esquire, known to me (or satisfactorily proven) to be a member of the bar of the highest court of said state and a subscribing witness to the within instrument and certified that he was personally present when John Jones, whose name is subscribed to the within instrument executed the same for the purposes therein contained. In witness hereof, I hereunto set my hand and official seal.


_________________________________
Notary Public


No one, other than a member of the Bar of the Supreme Court of Pennsylvania, may act as a subscribing witness before a notary public unless the principal is present at the time that the instrument is notarized.

 

By a Pennsylvania attorney-at-law pursuant to 20 P.S. 3132.1 under the probate code

Subscribed, sworn to and acknowledged before me by ___________________, known to me (or satisfactorily proven) to be the person described in the foregoing (Instrument or type of document) who acknowledged that he/she executed the same in the capacity therein stated, and for the purposes therein contained, and subscribed by ________________________ and ________________________, the witnesses, this _______ day of ________ 20__.

______________________________, Esquire
Member of the Bar of the
Supreme Court of Pennsylvania
I.D. #



On this, the____day of __________, 2013, before me a notary public, the undersigned officer, personally appeared Adam Smith, Esquire, known to me (or satisfactorily proven) to be a member of the bar of the highest court of said state and a subscribing witness to the within instrument and certified that he was personally present when John Jones, whose name is subscribed to the within instrument executed the same for the purposes therein contained.

In witness hereof, I hereunto set my hand and official seal.

_________________________________
Notary Public


No one, other than a member of the Bar of the Supreme Court of Pennsylvania, may act as a subscribing witness before a notary public unless the principal is present at the time that the instrument is notarized.

Acknowledgment of signing by mark

IN WITNESS WHEREOF, I, ____________________ being unable to sign my name because of advanced age or infirmity, have had my name subscribed for me and at my direction by (Witness #1), whereupon I have made my mark unassisted, in the space between my names, this________day of__________, 20__.


(First Name - written by witness)


*Subscriber’s Mark Here*


(Last Name - written by witness)


On this, the____day of__________, 20___, the above named (name of person making the mark) in our presence declared the above preceding (type of document) consisting of this and ___ other pages to be his/her own act or deed, and being unable to sign his/her name to the document because of advanced age and/or infirmity, directed his/her name to be subscribed for him/her, which the undersigned, (Name of Witness #1), did subscribe as directed, in his/her presence, made his/her mark in the space provided, between his/her name, and we, in his/her presence, and in the presence of each other have subscribed our
names as witnesses.
_______________________________
Witness #1

_______________________________
Witness #2


On this, the ____ day of _____________, 20___ before me, the undersigned officer, personally appeared___________________, known to me (or satisfactorily proven) to be the (declarer, grantor, etc), and, who being unable to affix his/her signature to the within instrument, placed his/her mark thereon, and directed his/her name to be subscribed thereto and acknowledge that he/she executed the same for the purposes therein contained.

In Witness Whereof I hereunto set my hand and official seal.


_________________________________
Notary Public

 

Acknowledgment by persons serving in or with the Armed Forces of the United States

In addition to the acknowledgment of instruments in the manner and form as otherwise now or hereafter authorized by the laws of this State or by this act, persons serving in or with the Armed Forces of the United States or their dependents wherever located may acknowledge the same before any commissioned officer in active service of the armed forces of the United States with the rank of Second Lieutenant or higher in the Army, Air Force or Marine Corps or Ensign or higher in the Navy or Coast Guard. The instrument shall not be rendered invalid by failure to state therein the place of execution or acknowledgment. No authentication of the officer’s certificate of acknowledgment shall be required but the officer taking the acknowledgment shall endorse thereon or attach thereto a certificate substantially in the following form:


On this_____day of__________, 20_____
Before me__________________________

The undersigned officer personally appeared ___________________(Serial No.) (if any) known to me (or satisfactorily proven) to be (serving in or with the
armed forces of the United States) (or a dependent of)________________(Serial No.) (if any) A person serving in or with the armed forces of the United States and to be the person whose name is subscribed to the within instrument and acknowledgment that he executed the same for the purposes therein contained. And the undersigned does further certify that he (she) is at the date of this certificate a commissioned officer of the rank stated below and is in the active service of the armed forces of the United States.


____________________________________
Signature of the Officer


____________________________________
Rank & Serial No. of Officer and
Command to which attached

 

Oaths

An oath is a formal declaration or promise to perform an act faithfully and
truthfully or an affirmation of the truth of a statement. Oaths are usually given for three purposes: (1) That a statement is the truth; (2) That the testimony he or she will be giving will be the truth; (3) That he or she will faithfully perform the duties of a public office.


SAMPLE OATHS

Notary: Do you solemnly swear that the statements contained in this
affidavit are true to the best of your knowledge and belief?

Affiant: I do.

Notary: Do you solemnly swear that the testimony that you are about to
give will be the truth, the whole truth, and nothing but the truth.

Affiant: I do.


Notary Public's Oath of Office

I, Joe Q. Notary, having been duly appointed and commissioned a Notary Public in and for the Commonwealth of Pennsylvania, do solemnly swear (or affirm) that I will support, obey and defend the Constitution of the United States and the Constitution of this Commonwealth and that I will discharge the duties of my office with fidelity.

 

Depositions

A deposition is an involuntary, or voluntary, sworn statement made by a witness for use in the witness’ absence at a legal proceeding. In taking a deposition, the notary should first make sure the witness is sworn in. The notary should then personally record or supervise the recording of the testimony of the witness. After the testimony is transcribed the notary should let the witness read and sign the transcribed copy of the deposition. The notary then certifies that the witness was sworn and that the document is a true and accurate record of the witness’ testimony. The deposition should be sealed in an envelope and filed with the court or sent to the prothonotary for filing. If a videotaped deposition is requested, the notary should make sure the witness is sworn. However, it is unnecessary to have a stenographic transcript and the witness’ signature. The videotape should be given to the attorney for the party requesting the deposition.

The certificate for a transcribed deposition should comply with the following format:

 

Certificate of Officer Before Whom Deposition is Taken

I,__________________(Name of Officer), a Certified Court Reporter and Notary Public do hereby certify that, pursuant to ________________(Specify the stipulation, notice or order of court under which the deposition was taken) the deposition of John Doe (Witness) was duly taken at ___________(Place) on __________(Date) at __________o’clock ___m. before me. The said John Doe (witness) was first duly sworn (or affirmed) by me according to law to tell the truth, the whole truth and nothing but the truth and thereupon did testify as set forth in the above transcript of testimony. The testimony was taken down by me or in my presence stenographically by _______(Name of stenographer) under my direction.

I do further certify that the above deposition is full, complete and a true record of all the testimony given by the said witness.
___________________________
Officer

 

Affidavits

An affidavit is a voluntary, written, sworn statement.

The name of the affiant, the person giving the statement, must be mentioned in the affidavit and the affiant is required to sign the affidavit in the notary’s presence. The notarization of an affidavit guarantees that (1) the affiant personally appeared before the notary public (2) that the affiant was identified by the notary public and (3) the affiant was sworn by the notary public to tell the truth.

 

SAMPLE AFFIDAVIT

Before me, the undersigned notary public, this day, personally, appeared _____________ to me known, who being duly sworn according to law, deposes the following:

(Affiant’s Statement)


(Signature of Affiant)


Subscribed and sworn to before
me this__________day of
_______________, 20___.
_____________________
Notary Public


(A corporation cannot give an affidavit. An officer of a corporation, however, can.)

The date of the notarization on an affidavit must always be the date that the affiant signed the affidavit. The Jurat is a certification by a notary or other authorized officer of the time, place and person before whom the affiant was sworn.

 

SAMPLE CREDIBLE WITNESS AFFIDAVIT:

Under the penalties of perjury, I (name of credible witness) declare that the person appearing before Alvin Notary is personally known to me as (name of person whose signature is to be notarized) and is the person named in the document requiring notarization.

_______________
Date

______________________________
Witness Signature

 

Sworn to and subscribed before me this 1st day of July, 2013, by (Name of Witness) who is personally known to me.
_________________________
Alvin Notary, Notary Public


A credible witness must be personally known to the notary and must personally know the signed and must appear with the signer.

 

Certificates

A notary public may certify that a document is an accurate copy of an original document, or that a statement is true. The notary public must make sure that the copy is exactly the same as the original.

Pennsylvania notaries public may not certify certain Federal, state or county records. Only the Custodians of Records of the agencies where these records are filed may certify copies, because they alone hold the original documents or records. This would include the following:

  • Birth records
  • Death records
  • Marriage records
  • Divorce Decree
  • Corporate records i.e. Articles of Incorporation

SAMPLE CERTIFICATE

I certify that the attached copy of a ________________________________ dated _____________________________ is a true, correct and complete copy of the original_________________________.


In witness whereof, I hereunto set my hand and official seal this ____ day of _______, 2006.


___________________________
Notary Public

 

Verification

A written statement of fact supported by oath or affirmation or made subject to the penalties of perjury under 18 Pa. C.S. 4904 that a statement or pleading is true, located at the end of a document.

SAMPLE VERIFICATION AFFIDAVIT FORM



I, John Smith, swear (or affirm) and verify that the statements made in the foregoing complaint are, to the best of my knowledge, information and belief, true and accurate.

Dated _____________

_______________________
John Smith


Subscribed and sworn to before me this__________day of________, 2013

_____________________________
Notary Public


SAMPLE NON AFFIDAVIT FORM

By signing below, I verify that this form is in the original format as supplied by ______________________ and has not been altered or otherwise modified in any way.

I am aware of the criminal penalties for tampering with public records or information pursuant to 18 Pa. C.S. §4904. Additionally, I certify that the statements in this application are true and correct to the best of my knowledge, information and belief, and that I am of good moral character. I understand that any false statement made is subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities.

Dated___________________

________________________
John Smith

 

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