JURAT WITH AFFIANT STATEMENT - Notary-NY - Public Notary
JURAT WITH AFFIANT STATEMENT
State of __________________}
} ss.
County of __________________}
( See Attached Document (Notary to cross out lines 1-6 below)
← See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary
1 __________________________________________________________________________
2 __________________________________________________________________________
3 __________________________________________________________________________
4 __________________________________________________________________________
5 __________________________________________________________________________
6 __________________________________________________________________________
________________________________ ____________________________________
Signature of Document Signer No. 1 Signature of Document Signer No. 2
Subscribed and sworn to (or affirmed) before me this _______day of _________________, _______, by
1) _________________________________
2) _________________________________
______________________________________
Signature of Notary Public
Place Notary Seal above
_______________________ OPTIONAL _______________________
Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document.
Further Description of Any Attached Document
Title or Type of Document: _______________________________________________________________
Document Date: ___________________________________ Number of Pages: ___________________
Signer[s] Other than above: _______________________________________________________________
-----------------------
Place Notary Seal above
................
................
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