Free notary acknowledgement 04
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Notary Template

State of: _______________________
County of: ______________________
On ____/____/______, before me,
______________________________,
Personally appeared,
_____________________________,
[__] Personally known to me
OR
[__] Proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and has hereby acknowledged to me that he/she/they have
executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the
instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the
instrument.

Witness my hand and official seal

________________________________
Notary Signature

________________________________
Print Name