Notary Public Report
I. Notary Public Information
Notary Public Name: [YOUR NAME]
Notary Public Number: [YOUR NOTARY NUMBER]
Commission Expiration Date: [YOUR COMMISSION EXPIRATION DATE]
II. Document Details
Type of Document Notarized: [TYPE OF DOCUMENT NOTARIZED]
Document Date: [DOCUMENT DATE]
Number of Pages: [NUMBER OF PAGES]
III. Signer's Information
Name of Signer: [NAME OF SIGNER]
Identification Provided: [IDENTIFICATION PROVIDED]
Documenting Number: [DOCUMENTING NUMBER]
Signer's Address: [SIGNER'S ADDRESS]
IV. Notarization Details
Notarization Type: Acknowledgment
Notary Act Performed: Sworn Statement (Jurat)
Witnesses Present: [NAMES OF WITNESSES PRESENT] (if applicable)
V. Fees and Other Charges
Notarization Fee: [NOTARIZATION FEE]
Additional Fees (If Any): [ADDITIONAL FEES]
Total Amount Charged: [TOTAL AMOUNT CHARGED]
VI. Notarization Statement
I, [YOUR NAME], a Notary Public for the state of [STATE], do hereby certify that on this day, [DATE], before me, personally appeared [NAME OF SIGNER], known to me to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed the same for the purposes therein contained.
VII. Notary Signature
Notary Signature
Date: January 20, 2050
VIII. Notary Seal
(Place Notary Seal Here)
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