West Virginia Code § 39-4-16

Short form certificates
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The following short form certificates of notarial acts are sufficient for the purposes
indicated, if completed with the information required by subsections (a) and (b), section
fifteen of this article:
(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: ..................g........
(2) For an acknowledgment in a representative capacity:
State of ....................
County of ....................
This record wVas 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: .......................... t
(4) For witnessing or attesting a signature:
State of ....................
County of ....................
Signed or attested before me on .....g................. [Date] by ...................................... [Name(s) of
individual(s) making statement]
..............................
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
Stam
Title of office ...........................................
My commission expires: ..........................

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