I, [Notary Name], who have been properly commissioned as a Notary Public within the jurisdiction of the State of [State Name], and currently residing at [Notary Address], do solemnly certify and declare under the potential penalties of perjury, the implication being that:

1. I am a currently commissioned Notary Public in the State of [State Name], and my commission is in full force and effect.

2. On [Date of Presentment], I presented the following document to [Recipient Name], located at [Recipient Address], for [Purpose of Presentment], as follows:

   • Title of Document: [Document Title]

   • Date of Document: [Document Date]

3. On the date previously mentioned, I was personally present and observed the event in which the document was formally presented to [Recipient Name].

4. [Recipient Name] acknowledged the receipt of the document, and he/she/they had the opportunity to review and/or sign the document as required.

5. I, hereby, on the specified date known as [Date of Certification], confirm that I am attaching or affixing my official signature and the recognized seal to this specific legal document referred to as the Affidavit of Notary Presentment Certification.

   Witness (if applicable)

   • Witness Name: [Witness Name]

   • Witness Address: [Witness Address]

   Notary Seal and Signature

   

   Name: [Notary's Public Name]

   Date: [Date of Notarization]

   Notary Seal:
   [Attach Notary Seal Here]

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