Sample Notary Statements are available for the following forms:
- Acknowledgements
- Oaths
- Depositions
- Affidavits
- Certificates
Acknowledgements
An acknowledgment is a formal declaration before an authorized official such as a notary, by a person who has signed a document, that the document is his or her act. Acknowledgments are governed by the Uniform Acknowledgment Act. Five forms are listed in that act. The person acknowledging the document must personally appear before the notary.
In addition, the person may sign the document in the notary's presence, or acknowledge that the signature on the document is his or her own.
To view the Uniform Acknowledgment Act, click here.
Sample Acknowledgment
Commonwealth of Pennsylvania)
)SS:
County of )
On this, the________day of __________, 20____, before me a notary public, the undersigned officer, personally appeared________________, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained.
In witness hereof, I hereunto set my hand and official seal.
___________________________
Notary Public
(1) For an individual acting in his or her own right:
Commonwealth Of Pennsylvania
County Of __________
The foregoing instrument was acknowledged before me this (date) by (name of person acknowledging) , who is personally known to me or who has produced (type of identification) as identification.
(Signature of person taking acknowledgment)
(Name typed, printed or stamped)
(Title or rank)
(Serial number, if any)
(2) For a corporation:
Commonwealth Of Pennsylvania
County Of __________
The foregoing instrument was acknowledged before me this (date) by (name of officer or agent, title of officer or agent) of (name of corporation acknowledging) , a (state or place of incorporation) corporation, on behalf of the corporation. He/she is personally known to me or has produced (type of identification) as identification.
(Signature of person taking acknowledgment)
(Name typed, printed or stamped)
(Title or rank)
(Serial number, if any)
(3) For a partnership:
Commonwealth Of Pennsylvania
County Of __________
The foregoing instrument was acknowledged before me this (date) by (name of acknowledging partner or agent) , partner (or agent) on behalf of (name of partnership) , a partnership. He/she is personally known to me or has produced (type of identification) as identification.
(Signature of person taking acknowledgment)
(Name typed, printed or stamped)
(Title or rank)
(Serial number, if any)
(4) For an individual acting as principal by an attorney in fact:
Commonwealth Of Pennsylvania
County Of __________
The foregoing instrument was acknowledged before me this (date) by (name of attorney in fact) as attorney in fact, who is personally known to me or who has produced (type of identification) as identification on behalf of (name of principal).
(Signature of person taking acknowledgment)
(Name typed, printed or stamped)
(Title or rank)
(Serial number, if any)
(5) By any public officer, trustee, or personal representative:
Commonwealth Of Pennsylvania
County Of __________
The foregoing instrument was acknowledged before me this (date) by (name and title of position) , who is personally known to me or who has produced (type of identification) as identification.
(Signature of person taking acknowledgment)
(Name typed, printed or stamped)
(Title or rank)
(Serial number, if any)
(6) For an acknowledgment in a representative capacity:
Commonwealth Of Pennsylvania
County Of __________
The foregoing instrument was acknowledged before me this _____ day of __________, 20 __________, by (name of person) as (type of authority, . . . e.g. officer, trustee, attorney in fact) for (name of party on behalf of whom instrument was executed).
(Signature of Notary Public - COMMONWEALTH OF Pennsylvania)
(Print, Type, or Stamp Commissioned Name of Notary Public)
Personally Known __________ OR Produced Identification __________
Type of Identification Produced
Oaths
An oath is a formal declaration or promise to perform an act faithfully and truthfully or an affirmation of the truth of a statement. Oaths are usually given for three purposes: (1) That a statement is the truth; (2) That the testimony he or she will be giving will be the truth; (3) That he or she will faithfully perform the duties of a public office.
SAMPLE OATHS
Notary: Do you solemnly swear that the statements contained in this affidavit are true to the best of your knowledge and belief?
Affiant:
I do.
Notary:
Do you solemnly swear that the testimony that you are about to give will be the truth, the whole truth, and nothing but the truth.
Affiant:
I do.
Notary Public's Oath of Office
Commonwealth of Pennsylvania )
)SS:
County of )
I, Joe Q. Notary, having been duly appointed and commissioned a Notary Public in and for the Commonwealth of Pennsylvania, do solemnly swear (or affirm) that I will support, obey and defend the Constitution of the United States and the Constitution of this Commonwealth and that I will discharge the duties of my office with fidelity.
Depositions
A deposition is an involuntary sworn statement made by a witness for use in the witness' absence at a legal proceeding.
In taking a deposition, the notary should first make sure the witness is sworn in. The notary should then personally record or supervise the recording of the testimony of the witness. After the testimony is transcribed the notary should let the witness read and sign the transcribed copy of the deposition. The notary then certifies that the witness was sworn and that this document is a true and record of the witness' testimony. The deposition should be sealed in an envelope and filed with the court or sent to the prothonotary for filing.
If a videotaped deposition is requested, the notary should make sure the witness is sworn. However, it is unnecessary to have a stenographic transcript and the witness' signature. The videotape should be given to the attorney for the party requesting the deposition.
The certificate for a transcribed deposition should comply with the following format:
Commonwealth of Pennsylvania )
)SS:
County of )
Certificate of Officer Before Whom Deposition is Taken
I,______________________(Name of Officer), a_________________(Title) do hereby certify that, pursuant to________________(Specify the stipulation, notice or order of court under which the deposition was taken) the deposition of __________(Name of Witness) was duly taken at___________(Place) on___________(Date) at ___________o'clock ___m. before me. The said__________________(Name of witness) was first duly sworn (or affirmed) by me according to law to tell the truth, the whole truth and nothing but the truth and thereupon did testify as set forth in the above transcript of testimony. The testimony was taken down in my presence stenographically by_______(Name of stenographer) under my direction.
I do further certify that the above deposition is full, complete and true record of all the testimony given by the said witness.
___________________________________
Officer
Affidavits
An affidavit is a voluntary, sworn written statement.
The name of the affiant, the person giving the statement, must be mentioned in the affidavit and the affiant is required to sign the affidavit in the notary's presence.
Sample Affidavit
Commonwealth of Pennsylvania )
)SS:
County of )
Before me, the undersigned notary public, this day, personally, appeared______________ to me known, who being duly sworn according to law, deposes the following:
Affiant's Statement)
(Signature of Affiant)
Subscribed and sworn to before me this__________day of_______________,19___.
___________________________
Notary Public
CERTIFICATES
A notary public may certify that a document is an accurate copy of an original document, or that a statement is true. The notary public must make sure that the copy is exactly the same as the original.
Pennsylvania Notaries public may not certify certain Federal, State or County records. Only the agencies where these records are filed may certify copies, because they alone hold the original documents or records. This would include the following types of documents:
Birth records
Death records
Marriage records
Corporate records i.e. Articles of Incorporation
Sample Certificate
Commonwealth of Pennsylvania )
)SS:
County of )
I certify that the attached copy of a ____________dated is a true, correct and complete copy of the original_________________________.
In witness whereof, I hereunto set my hand and official seal.
___________________________
Notary Public
Study Materials
