§ 47-43-4

\nWhen the execution of an instrument is proved by proof of the signature of a subscribing witness as provided by G.S. 47-12.1, the certificate required by G.S. 47-13.1 shall be in substantially the following form:\nSTATE OF________________________________________\n(Name of state)\n_________________________________________ COUNTY\nI, ____________________________, a ______________________________________\n(Name of officer taking proof) (Official title of officer taking proof)\nof ___________________ COUNTY, _______________________________, certify that\n(Name of state)\n____________________________________ personally appeared before me this day, and\n(Name of person familiar with\nhandwriting of subscribing witness)\nbeing duly sworn, stated that he knows the handwriting of ________________________,\n(Name of subscribing witness)\nand that the signature of __________________________ as a subscribing witness to the\n(Name of subscribing witness)\nforegoing instrument is the signature of _______________________________________\n(Name of subscribing witness)\nWITNESS my hand and

__ as a subscribing witness to the\n(Name of subscribing witness)\nforegoing instrument is the signature of _______________________________________\n(Name of subscribing witness)\nWITNESS my hand and official seal, this the ____ day of ______________, ________\n(Month) (Year)\n(Signature of officer taking proof)\n(Official title of officer taking proof)\nMy commission expires _________________________________________________\n(Date of expiration of officer's commission)\n(1951, c. 379, s. 3; 1999-456, s. 59.)