Legal Witness Notary Form

Document Title:

Date:

Location:

Declarant Information

Full Name:

Address:

Phone Number:

Email:

Witness Information

Full Name:

Address:

Phone Number:

Notary Public Information

Full Name:

License/Commission Number:

Expiration Date:

State/Country:

Acknowledgment by Affiant/Declarant

I, the undersigned, acknowledge that the information provided is true and accurate to the best of my knowledge.

Signature of Affiant:

Date:

Witness Acknowledgment

We, the undersigned, verify that the affiant signed the document in our presence and of their own free will.

Signature Witness 1:

Date:

Signature Witness 2:

Date:

State of
County of

On this day of , 20, before me, the undersigned Notary Public, personally appeared (Affiant), who proved to me through satisfactory evidence of identification, to be the person whose name is signed above.

I certify under penalty of perjury that the foregoing is true and correct.

Signature of Notary Public:

Date:

Seal

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