§ 39-4-16

The following short form certificates of notarial acts are sufficient for the purposes indicated, if completed with the information required by subsections (a) and (b), section fifteen of this article:(1) For an acknowledgment in an individual capacity:State of .....................................County of ...................................This record was acknowledged before me on .............. [Date] by ........................................ [Name(s) of individual(s)]............................................................Signature of notarial officerStampTitle of office ...........................................My commission expires: ..........................(2) For an acknowledgment in a representative capacity:State of ....................County of ....................This record was acknowledged before me on .............. [Date] by ....................................................... [Name(s) of individual(s)] as ............................ [Type of authority, such as officer or trustee] of .......................... [Name of party on behalf of whom record was executed]...............................Signature of notarial officerStampTitle of

of authority, such as officer or trustee] of .......................... [Name of party on behalf of whom record was executed]...............................Signature of notarial officerStampTitle of office........................................My commission expires: ..........................(3) For a verification on oath or affirmation:State of ....................County of ....................Signed and sworn to (or affirmed) before me on ............ (Date) by .................................................... [Name(s) of individual(s) making statement]..............................Signature of notarial officerStampTitle of office .............................................My commission expires: ..........................(4) For witnessing or attesting a signature:State of ....................County of ....................Signed or attested before me on ...................... [Date] by ...................................... [Name(s) of individual(s) making statement]..............................Signature of notarial officerStampTitle of office ............................................My commission expires: ..........................(5) For certifying a copy of a

..........................Signature of notarial officerStampTitle of office ............................................My commission expires: ..........................(5) For certifying a copy of a record:State of ....................County of ....................I certify that this is a true and correct copy of a record in the possession of ......................................Dated .........................................................Signature of notarial officerStamTitle of office ...........................................My commission expires: ..........................