Notary Letter for Religious Exemption

I, [YOUR NAME], a duly licensed notary public in the state of [YOUR STATE], hereby testify that [REQUESTER'S NAME], came before me this day, and declared the following under the penalty of perjury:

I. Identification Confirmation

On this [DATE], before me, the undersigned, [YOUR NAME], a duly commissioned notary public in and for the state of [YOUR STATE], personally appeared [REQUESTER'S NAME]. The requester presented a government-issued photo identification, which I verified to be valid and current. Based on my examination of the presented identification, I confirm that the requester is indeed the person whose name is subscribed on this document.

II. Declaration of Religious Belief

[REQUESTER'S NAME] solemnly affirms the following under the principles of the [RELIGION] faith:

Adherence to [RELIGION] Faith: [REQUESTER'S NAME] asserts a devout commitment to the principles and teachings of the [RELIGION] faith, deeply held and integral to their personal beliefs and values.
Religious Exemption Request: According to [REQUESTER'S NAME]'s sincerely held religious convictions, they seek exemption from [SPECIFY THE LAW, RULE, OR REQUIREMENT FROM WHICH EXEMPTION IS SOUGHT]. This request is rooted in the fundamental tenets of their faith, which guide their actions and decisions in all aspects of life.

III. Exempting Rules/Laws

[LAW/RULE #1]: Vaccination Requirement Exemption

[Requester's Name] seeks exemption from the vaccination requirement for school-aged children due to sincerely held religious beliefs.
[LAW/RULE #2]: Workplace Safety Regulations Exemption

[Requester's Name] requests exemption from workplace safety regulations regarding personal protective equipment (PPE) usage based on documented medical grounds.
[LAW/RULE #3]: Educational Mandate Exemption

[Requester's Name] is seeking exemption from educational mandates due to unique circumstances related to [his/her/their] educational needs.

[Provide additional context or details as necessary.]

IV. Affirmation of Sincerity

The individual referenced as the [REQUESTER'S NAME] here, adopts an earnest stance in affirmation and declaration that the affiliations and proclamations to which they are linked are unquestionably authentic and sincere. Furthermore, they assert emphatically that these commitments or declarations are not propelled by any underlying motive to obscure, avoid, or circumvent any governing laws, regulations, or mandatory prerequisites.

V. Notary Confirmation

Being fully confident of the sincere declaration made by the affiant, I, [YOUR NAME], as a notary public, attest that [REQUESTER'S NAME] has verified their sincere religious concerns in my presence.

I have hereunto set my hand and official seal at my office in [YOUR CITY, YOUR STATE], this [DATE].

[YOUR NAME]
[YOUR TITLE]
[YOUR SEAL]

Note: This affirmation was made under the penalty of perjury, a punishable offense under state law.