Signature affixed by Notary Public Certificate



SIGNATURE BY NOTARY & ACKNOWLEDGEMENT Gov. Exec. Ord. #455 (04-04) § 5

The Notary Public signed for principal in presence of:

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Signature affixed by Notary Public for

and in the presence of the principal:

_____________________________

_____________________________

_____________________________

The Commonwealth of Massachusetts

_________________ ss.

On this _____ day of ___________________, 20___, before me, the undersigned officer, personally appeared _________________________________, proved to me through satisfactory evidence of identity, to wit, __________________, to be the person(s) whose name(s) is/are signed on the attached document and who acknowledged to me that _______ signed it voluntarily for its stated purpose.

OPTIONAL

Although the information in this section 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.

Be sure to read the applicable law regarding the Notary Public signing for the principal on back.

Right Thumbprint

Description of Attached Document(s)

Title or Type of Document: _______________________________________

Document Date: ____/____/_____ Number of Pages: _________________

Misc. Info/Signers: ______________________________________________

__________________________________

__________________________________

Commission Expiration: ___/___/____

APPLICABLE LAW RELATING TO NOTARY AS SIGNER

Pursuant to the Governor’s Executive Order 455 (04-04) § 5 §§ I: A Notary Public may sign the name of a principal who is physically unable to sign or make a mark on a document presented for notarization if:

 

1) the principal directs the Notary to do so in the presence of two (2) witnesses who are unaffected by the document;

 

2) the principal does not have a demeanor that causes the Notary Public

to have a compelling doubt about whether the principal knows the

consequences of the transaction requiring the Notarial act;

 

3) in the Notary Public’s judgment, the principal is acting of his or her

own free will;

 

4) the Notary Public signs the principal’s name in the presence of the

principal and the witnesses;

(5) both witnesses sign their own names beside the signature;

 

6) the Notary Public writes below the signature: “Signature affixed by

Notary Public in the presence of (names and addresses of principal

and two [2] witnesses)"; and

 

7) the Notary Public notarizes the signature through a signature

witnessing, acknowledgment, or jurat.

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