41-265. Short form certificates The following short form certificates of notarial acts are sufficient for the purposes indicated, if completed with the information required by section 41-264, subsections A and B: 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 Stamp (_____________________________________) Title of office (My commission expires: _____________) 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 (type of authority, such as officer or trustee) of (name of party on behalf of whom record was executed). ________________________________________ Signature of notarial officer Stamp (_______________________________________) Title of office (My commission expires: _______________) 3. For a verification on oath or affirmation: State of _________________________________________ (County) of ______________________________________ Signed and sworn to (or affirmed) before me on ___________ Date by ________________________________________________________ Name(s) of individual(s) making statement __________________________________________ Signature of notarial officer Stamp (_________________________________________) Title of office (My commission expires: __________________) 4. For witnessing or attesting a signature: State of _________________________________________ (County) of ______________________________________ Signed (or attested) before me on ________________ Date by _______________________________________________ Name(s) of individual(s) ___________________________________________ Signature of notarial officer Stamp (__________________________________________) Title of office (My commission expires: ___________________) 5. For certifying a copy of a record: State of ________________________________________ (County) of _____________________________________ I certify that this is a true and correct copy of a record in the possession of _________________________________. Dated _______________________________ _____________________________________ Signature of notarial officer Stamp (____________________________________) Title of office (My commission expires: _____________) 6. For certifying a tangible copy of an electronic record: State of _______________________________________________ (County) of ____________________________________________ I certify that the foregoing copy of a record (entitled ________) (dated _______) and containing ________ pages is an accurate copy of an electronic record. Dated ____________________________________ __________________________________________ Signature of notarial officer Stamp (_________________________________________) Title of office (My commission expires: __________________)
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