Notary Attestation Statement

I. Notary Public Details

Name: [YOUR NAME]
License Number: [YOUR LICENSE NUMBER]
Effective Date: [YOUR EFFECTIVE DATE]
Expiration Date: [YOUR EXPIRATION DATE]

II. Signatory's Details

Name: [SIGNATORY'S NAME]
Identification Type: [ID TYPE]
Identification Number: [ID NUMBER]
Issue Date: [ID ISSUE DATE]
Expiration Date: [ID EXPIRATION DATE]

III. Verification Statement

On this day, [DATE], in the county of the state of [STATE], I,[YOUR NAME], a notary public, do hereby certify that [SIGNATORY'S NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed within the document, appeared before me and acknowledged that they executed the same for the purposes therein contained.

IV. Notary Attestation

I, [YOUR NAME], a notary public for the state of [STATE], do further certify that the said [SIGNATORY'S NAME] voluntarily and willingly signed the foregoing instrument and acknowledged it to be their free act and deed for the purposes therein mentioned.

V. Additional Clause(s)

1. [ANY ADDITIONAL CLAUSE 1]

2. [ANY ADDITIONAL CLAUSE 2]

3. [ANY ADDITIONAL CLAUSE 3]

[Your Name] (Notary Public):

[Date Signed] (Date):

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