When the execution of an instrument is proved by proof of the signature of the maker as provided by G.S. 47-12.1 or as provided by G.S. 47-13, 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, (Name of person familiar with maker's handwriting) and being duly sworn, stated that he knows the handwriting of______________________ (Name of maker) and that the signature to the foregoing instrument is the signature of _________________ (Name of maker) 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)
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