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This Notary Jurat goes at the end of your legal document, if you intend to notarize your document under penalty of perjury.


State of _______________________)

Subscribed and Affirmed         )

County of ______________________)

On ____________________, 200___ before me ________________________________personally appeared ________________________________ personally known to me (proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument, and acknowledged to me that he executed same in his authorized capacity, and that by his signature on the instrument the person or the entity upon behalf of which the person acted, executed the instrument.

I now affix my signature and official seal to these affirmations.




Signature of Notary Public: _______________________________________________