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)
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