STATE OF ___________________

COUNTY OF __________________

_______________________, herewith declares under the penalties of perjury:

That they are competent under the law to give this declaration and unless stated have personal knowledge of the facts stated herein:

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Notary

Expiration Expires

Declaration Under the Penalty of Perjury, Notary Statement

Review List

This review list is provided to inform you about this document in question and assist you in its preparation.  This statement can go at the end of a notary witnessing, if you so choose.  It is a more formal and pointed way for the notary to witness a signature.

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