I. Identification and Confirmation

This part of the notary statement is made and signed by the Notary, [YOUR NAME], and is addressed to the individual(s) or entity/entities for whom the affidavit is made.

A. Name of the Affiant: [AFFIANT FULL NAME]
B. Date of the affidavit: [DATE OF THE AFFIDAVIT]
C. Relationship to the party/parties of Interest: [RELATIONSHIP TO PARTY/PARTIES]

II. Address & Contact Information

Use the fields in this segment to provide the affiant's contact and address information.

The present Address of the Affiant: [AFFIANT ADDRESS]

Contact Details of the Affiant:
Email: [AFFIANT EMAIL]
Phone: [AFFIANT PHONE NUMBER]

III. Notary Statement

The notary’s affidavit statement, confirms details of the party involved.

On this [DAY] day of [MONTH], [YEAR], before me, [YOUR NAME], personally appeared [AFFIANT NAME], 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.

IV. Notary Seal and Signature

This section should include a physical or digital impression of the notary's seal and signature.

In Witness whereof, the said Notary has set his hand and seal on the date hereinabove written.

[YOUR NAME]: Notary Public
My Commission Expires:[COMMISSION EXPIRY DATE]

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