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SAMPLE FORMS
In the following examples a
personalized seal means: the words "Notary
Public, State of Texas" around a star of five
points, the Notary Public's name, and the date
the Notary Public's commission expires.
ACKNOWLEDGMENTS
| I. Form for Ordinary
Certificate of Acknowledgment |
State of Texas
County of _______________
Before me, (insert the name
and character of the officer),
on this day personally appeared
____________________, known to me
(or proved to me on the oath of
______________ or through
(description of identity card or
other document)) to be the person
whose name is subscribed to the
foregoing instrument and
acknowledged to me that he executed
the same for the purposes and
consideration therein expressed.
Given under my hand and seal of
office this __________ day of
__________, (year).
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______________________
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Notary Public's Signature
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(Personalized Seal)
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| II. Short Forms |
A. For a natural person acting
in his/her own right:
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State of Texas
County of _______________
This instrument was acknowledged
before me on (date) by
(name or names of person or persons
acknowledging).
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______________________
Notary Public's Signature
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(Personalized Seal)
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B. For a natural person as
principal acting by
attorney-in-fact:
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State of Texas
County of _______________
This instrument was acknowledged
before me on (date) by
(name of attorney-in-fact) as
attorney-in-fact on behalf of
(name of principal).
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______________________
Notary Public's Signature
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(Personalized Seal)
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C. For a partnership acting by
one or more partners:
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State of Texas
County of _______________
This instrument was acknowledged
before me on (date) by
(name of acknowledging partner or
partners), partner(s) on behalf
of (name of partnership), a
partnership.
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______________________
Notary Public's Signature
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(Personalized Seal)
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D. For a corporation:
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State of Texas
County of _______________
This instrument was acknowledged
before me on (date) by
(name of officer), (title of
officer) of (name of
corporation acknowledging), a
(state of incorporation)
corporation, on behalf of said
corporation.
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______________________
Notary Public's Signature
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(Personalized Seal)
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E. For a public officer,
trustee, executor, administrator,
guardian, or other representative:
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State of Texas
County of _______________
This instrument was acknowledged
before me on (date) by
(name of representative) as
(title of representative) of
(name of entity or person
represented)
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______________________
Notary Public's Signature
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(Personalized Seal)
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F. Form of Certificate for
Proof by Witness
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State of Texas
County of _______________
Before me, (insert the name and
character of the officer), on this
day personally appeared
____________________, known to me
(or proved to me on the oath of
______________), to be the person
whose name is subscribed as a
witness to the foregoing instrument
of writing, and after being duly
sworn by me stated on oath that he
saw _______, the grantor or person
who executed the foregoing
instrument, subscribe the same (or
that the grantor or person who
executed such instrument of writing
acknowledged in his presence that he
had executed the same for the
purposes and consideration therein
expressed), and that he had signed
the same as a witness at the request
of the grantor (or person who
executed the same.)
Given under my
hand and seal of office this
__________ day of __________,
(year).
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______________________
Notary Public's Signature
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(Personalized Seal)
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| JURAT |
State of Texas
County of _______________
Sworn to and subscribed before me on
the __________ day of
_______________, (year), by
(name of signer).
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______________________
Notary Public's Signature
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(Personalized Seal)
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| VERIFICATIONS |
Form 1:
State of Texas
County of _______________
_______________, personally appeared
before me, and being first duly
sworn declared that he/she signed
this application in the capacity
designated, if any, and further
states that he/she has read the
above application and the statements
therein contained are true.
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______________________
Notary Public's Signature
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(Personalized Seal)
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Form 2:
State of Texas
County of _______________
Before me, a
notary public, on this day
personally appeared _______________,
known to me to be the person whose
name is subscribed to the foregoing
document and, being by me first duly
sworn, declared that the statements
therein contained are true and
correct.
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______________________
Notary Public's Signature
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(Personalized Seal)
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| OATH OR
AFFIRMATION |
State of Texas
County of _______________
I, (affiant), do
solemnly swear (or affirm), that I
will faithfully execute the duties
of the office of ___________________
of the State of Texas, and will to
the best of my ability preserve,
protect, and defend the Constitution
and laws of the United States and of
this State, so help me God.
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_____________________
Signature of Affiant
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Sworn to and subscribed before me by
(affiant) on this __________
day of _______________, (year).
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______________________
Notary Public's Signature
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(Personalized Seal)
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| STATEMENT OF
OFFICER |
I, (affiant), do solemnly swear (or
affirm) that I have not directly or
indirectly paid, offered, promised
to pay, contributed, or promised to
contribute any money or thing of
value, or promised any public office
or employment for the giving or
withholding of a vote at the
election at which I was elected or
as a reward to secure my appointment
or confirmation, whichever the case
may be, so help me God.
UNDER PENALTIES
OF PERJURY, I DECLARE THAT I HAVE
READ THE FOREGOING STATEMENT AND
THAT THE FACTS STATED THEREIN ARE
TRUE.
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_____________________
Date
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_____________________
Affiant's Signature
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| DEPOSITION |
Certificate to Deposition Upon
Written Questions
State of Texas
County of _______________
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(Plaintiff)
v.
(Defendant) |
)
)
)
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In
the __________ Court
of __________ County, Texas
Cause No. __________ |
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I hereby certify that the foregoing
answers of __________, the witness
forenamed, were signed and sworn to
before me on (date), by said
witness.
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______________________
Notary Public's Signature
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(Personalized Seal)
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| PROTESTS |
(Insert bill or note or copy
thereof)
United States of America
State of Texas
County of _______________
Be it known that on the __________
day of __________, (year), at
the request of (name), of
__________, I, (Notary Public's
name), a Notary Public duly
commissioned and sworn, residing in
__________ County, Texas, did
present the original
(instrument), hereto attached,
for $__________, with accrued
interest thereon of $__________,
dated __________, and demanded
payment (or acceptance) thereof,
which was refused.
Whereupon I, at the request of
the aforesaid __________, did
protest, and by these presents do
protest, as well against the drawer,
maker, endorsers, and acceptors of
said instruments as against all
others whom it may concern, for
exchange, costs, charges, damages,
and interest already incurred and
hereinafter to be incurred by reason
of non-payment thereof. I further
certify that on (date),
notice in writing of the foregoing
presentment, demand, refusal and
protest was given by (persons and
status) by depositing notices
thereof in the post office at
__________, Texas, postage paid,
directed as follows:
____________________. I further
certify that notices were left as
follows:
Notice left for _______________
at _______________
Notice left for _______________ at
_______________
Each of the named places the
reputed place of residence of the
person for whom the notice was left.
In testimony whereof I have
hereunto set my hand and affixed my
seal of office at __________, Texas,
on __________ day of __________,
(year).
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______________________
Notary Public's Signature
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(Personalized Seal)
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(List fees and expenses to
include postage)
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| CERTIFIED COPY OF
A NON-RECORDABLE DOCUMENT |
State of Texas
County of _______________
On this __________ day of
__________, (year), I certify
that the preceding or attached
document, and the duplicate retained
by me as a notarial record, are
true, exact, complete, and unaltered
photocopies made by me of
(description of document),
presented to me by the document's
custodian, _______________, (*held
in my custody as a notarial record)
and that, to the best of my
knowledge, the photocopied document
is neither a public record nor a
publicly recordable document,
certified copies of which are
available from an official source
other than a notary.
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______________________
Notary Public's Signature
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(Personalized Seal)
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*This phrase would be
inserted and the proceeding phrase,
"presented to me by the document's
custodian", would be deleted in the
event a person was requesting a
certified copy of the Notary
Public's journal.
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