Notary Certificate of Dishonor

I. Prepared By

The document referred to as the Notary Certificate of Dishonor has been thoroughly prepared by [Your Name]. I hold the position and carry the responsibilities of a notary public, duly commissioned, and fully licensed as per the legislative requirements. My current place of residence is in the city of [Your Company Address] which is located within the boundaries of the state of [State].

II. Certificate Details

• Certificate Number: [Certificate Number]

• Date of Issuance: [Date of Issuance]

• Issuing Authority: [Your Company Name]

• Jurisdiction: [Jurisdiction]

III. Certificate Recipient

This Notary Certificate of Dishonor is issued to:

• Name: [Recipient's Name]

• Address: [Recipient's Address]

IV. Instrument Details

• Type of Instrument: Check

• Instrument Number/Identifier: 56789123

• Date of Instrument: April 12, 2050

• Amount: $1,250.75

V. Reason for Dishonor

The instrument described above has been presented for payment and has been dishonored due to:

• Insufficient funds.

• Closed account.

• Stop payment order.

• Irregular signature.

• Alteration of instrument.

• Other reasons specified by law: [Specify Other Reasons]

VI. Notary Attestation

I, [Your Name], as a duly appointed and currently active Notary Public, am the individual who is undersigned on this document. I solemnly and forthrightly certify, and this is under the potential penalties associated with perjury, that all of the information provided herein, also referred to as the 'foregoing', is true and correct to the best extent of my current knowledge and deeply held belief.

VII. Notary Acknowledgment

On this [Date of Notarization], before me, [Your Name], a Notary Public, personally appeared [Your Name], known to me (or proved to me based on satisfactory evidence) to be the person whose name is subscribed to the within instrument, and acknowledged to me that he/she executed the same in his/her authorized capacity and that by his/her signature on the instrument, the person, or entity upon behalf of which the person acted, executed the instrument.

VIII. Notary Seal and Signature

Printed Name of Client: [Client's Name]

Date: [Date Signed]

Printed Name of Notary Public: [Your Name]

Date: [Date Signed]

Notary Seal (if applicable): [Seal]

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