Article 3.
Forms of Acknowledgment, Probate and Order of Registration.
§ 47-37: Repealed by Session Laws 2005-123, s. 3, effective October 1, 2005.
§ 47-37.1. Other forms of proof.
(a) The proof and acknowledgment forms set forth in this Article are not exclusive. Without regard to whether an instrument presented for registration was signed by an individual acting in his or her own right or by an individual acting in a representative or fiduciary capacity, a notarial certificate that complies with the provisions of Part 6 of Article 1 or Part 5 of Article 2 of Chapter 10B of the General Statutes is deemed a sufficient form of probate or acknowledgment for purposes of this Chapter. Use of a notarial certificate that satisfies the requirements of Part 6 of Article 1 or Part 5 of Article 2 of Chapter 10B of the General Statutes is not a ground for a register of deeds to refuse to accept a record for registration.
(b) When an instrument presented for registration purports to be signed by an individual in a representative or fiduciary capacity, the acknowledgment or proof of that individual's signature may do any of the following:
(1) State that the individual signed the instrument in a representative or fiduciary capacity.
(2) State that the individual who signed the instrument in a representative or fiduciary capacity had authority to do so.
(3) Identify the represented person or the fiduciary capacity.
(c) This section relates only to the form of proof or acknowledgment. The capacity and authority of the individual who signs an instrument presented for registration are governed by other provisions of law.
(d) Repealed by Session Laws 2021-91, s. 7, effective October 1, 2021. (2005-391, s. 9; 2006-59, s. 27; 2021-91, s. 7.)
§ 47-38. Acknowledgment by grantor.
When properly completed, a certificate in substantially the following form may be used and shall be sufficient under the law of this State to satisfy the requirements for a notarial certificate for one or more individuals, acting in his, her, or their own right or, whether or not so stated in the notarial certificate, in a representative or fiduciary capacity, including one or more individuals acting on behalf of an unincorporated association, as an officer or director of a corporation, as a partner of a general or limited partnership, as a manager or member of a limited liability company, as the trustee of a trust, as the personal representative of a decedent's estate, as an agent or attorney in fact for another, as the guardian of a minor or an incompetent, or as a public official. The authorization of the form in this section does not preclude the use of other forms. This section applies to notarial certificates made before, on, and after December 1, 2005.
North Carolina, ______________ County.
I (here give the name of the official and his official title), do hereby certify that (here give the name of the individual whose acknowledgment is being taken) personally appeared before me this day and acknowledged the due execution of the foregoing instrument. Witness my hand and (where an official seal is required by law) official seal this the ____________ day of _____ (year).
(Official seal.)
(Signature of officer.)
(Title)
(Rev., s. 1002; C.S., s. 3323; 1945, c. 73, s. 13; 1977, c. 375, s. 12; 2006-59, s. 28.)
§ 47-39. Repealed by Session Laws 1977, c. 375, s. 16, effective January 1, 1978.
§ 47-40. Husband's acknowledgment and wife's acknowledgment before the same officer.
Where the instrument is acknowledged by both husband and wife or by other grantor before the same officer the form of acknowledgment shall be in substance as follows:
I (here give name of official and his official title), do hereby certify that (here give names of the grantors whose acknowledgment is being taken) personally appeared before me this day and acknowledged the due execution of the foregoing (or annexed) instrument.
(1899, c. 235, s. 8; 1901, c. 299; Rev., s. 1004; C.S., s. 3325; 1945, c. 73, s. 15.)
§ 47-41: Repealed by Session Laws 1991, c. 647, s. 3.
§ 47-41.01. Corporate conveyances.
(a) The following forms of probate for deeds and other conveyances executed by a corporation shall be deemed sufficient, but shall not exclude other forms of probate which would be deemed sufficient in law.
(b) If the deed or other instrument is executed by an official of the corporation, signing the name of the corporation by him in his official capacity, or any other agent authorized by resolution pursuant to G.S. 47-18.3(e), is sealed with its common or corporate seal, and is attested by another person who is an attesting official of the corporation, the following form of acknowledgment is sufficient:
(State and county, or other
description of place where
acknowledgment is taken)
I, , ,
(Name of officer taking (Official title of officer
acknowledgment) taking acknowledgment)
certify that ___________________________ personally came before
(Name of attesting official)
me this day and acknowledged that he (or she) is ________________________
(Title of attesting official)
of_____________________, a corporation, and that by authority duly
(Name of corporation)
given and as the act of the corporation, the foregoing instrument was signed in its name by its__________________________,
(Title of official)
sealed with its corporate seal, and attested by himself (or herself) as its __________________________
(Title of attesting official)
Witness my hand and official seal, this the _______ day of
____________,
(Month)
____________
(Year)
___________________________________________
(Signature of officer taking acknowledgment)
(Official seal, if officer taking
acknowledgment has one)
My commission expires _____________________________________
(Date of expiration of commission as
notary public)
(c) If the deed or other instrument is executed by an official of the corporation, signing the name of the corporation in his official capacity, or any other agent authorized by resolution pursuant to G.S. 47-18.3(e) the following form of acknowledgment is sufficient:
(State and county, or other
description of place where
acknowledgment is taken)
I,_______________________ , _____________________________,
(Name of officer taking (Official title of officer
acknowledgment) taking acknowledgment)
certify that _______________________ personally came before
(Name of official)
me this day and acknowledged that he (or she) is _____________________
(Title of official)
of________________________, a corporation, and that he/she, as
_________________________, being authorized to do so, executed the
(Title of official)
foregoing on behalf of the corporation.
Witness my hand and official seal, this the _______ day of
____________,
(Month)
____________
(Year)
____________________________________________
(Signature of officer taking acknowledgment)
(Official seal, if officer taking
acknowledgment has one)
My commission expires _____________________________________
(Date of expiration of commission as
notary public)
(d) For purposes of this section:
(1) The words "a corporation" following the blank for the name of the corporation may be omitted when the name of the corporation ends with the word "Corporation" or "Incorporated."
(2) The words "My commission expires" and the date of expiration of the notary public's commission may be omitted except when a notary public is the officer taking the acknowledgment. The fact that these words and this date may be located in a position on the form different from the position indicated in this subsection does not by itself invalidate the form.
(3) The phrase "and official seal" and the seal itself may be omitted when the officer taking the acknowledgment has no seal or when such officer is the clerk, assistant clerk, or deputy clerk of the superior court of the county in which the deed or other instrument acknowledged is to be registered.
(4) The official of the corporation is the corporation's chairman, president, chief executive officer, a vice-president or an assistant vice-president, treasurer, or chief financial officer, or any other agent authorized by resolution pursuant to G.S. 47-18.3(e).
(5) The attesting official of the corporation is the corporation's secretary or assistant secretary, trust officer, assistant trust officer, associate trust officer, or in the case of a bank, its secretary, assistant secretary, cashier or assistant cashier.
(6) The phrase "sealed with its corporate seal" may be omitted if the seal of the corporation has not been affixed to the instrument being acknowledged.
(e) The forms of probate set forth in this section may be modified and adopted for use in the probate of deeds and other conveyances and instruments executed by entities other than corporations, including general and limited partnerships, limited liability companies, trusts, and unincorporated associations. This subsection applies to notarial certificates and forms of probate made before, on, or after December 1, 2005. (1991, c. 647, s. 4; 1995 (Reg. Sess., 1996), c. 742, s. 18; 1999-221, s. 1; 2006-59, s. 29.)
§ 47-41.02. Other forms of probate for corporate conveyances.
(a) The following forms of probate for deeds and other conveyances executed by a corporation shall also be deemed sufficient but shall not exclude other forms of probate which would be deemed sufficient in law.
(b) If the instrument is executed by the president or presiding member or trustee and two other members of the corporation, and sealed with the common seal, the following form shall be sufficient:
North Carolina, ____________________ County.
This ______ day of ________ A.D.________, personally came before me (here give the name and official title of the officer who signs this certificate) A.B. (here give the name of the subscribing witness), who, being by me duly sworn, says that he knows the common seal of the (here give the name of the corporation), and is also acquainted with C.D., who is the president (or presiding member or trustee), and also with E.F. and G.H., two other members of said corporation; and that he, the said A.B., saw the said president (or presiding member or trustee) and the two said other members sign the said instrument, and saw the said president (or presiding member or trustee) affix the said common seal of said corporation thereto, and that he, the said subscribing witness, signed his name as such subscribing witness thereto in their presence. Witness my hand and (when an official seal is required by law) official seal, this ____ day of ______ (year).
(Official seal.)
(Signature of officer.)
(c) If the deed or other instrument is executed by the president, presiding member or trustee of the corporation, and sealed with its common seal, and attested by its secretary or assistant secretary, either of the following forms of proof and certificate thereof shall be deemed sufficient:
North Carolina, ____________________ County.
This _________ day of___________, A.D.___________, personally came before me (here give name and official title of the officer who signs the certificate) A.B. (here give the name of the attesting secretary or assistant secretary), who, being by me duly sworn, says that he knows the common seal of (here give the name of the corporation), and is acquainted with C.D., who is the president of said corporation, and that he, the said A.B., is the secretary (or assistant secretary) of the said corporation, and saw the said president sign the foregoing (or annexed) instrument, and saw the said common seal of said corporation affixed to said instrument by said president (or that he, the said A.B., secretary or assistant secretary as aforesaid, affixed said seal to said instrument), and that he, the said A.B., signed his name in attestation of the execution of said instrument in the presence of said president of said corporation. Witness my hand and (when an official seal is required by law) official seal, this the ___________ day of ____________ (year).
(Official seal.)
(Signature of officer.)
North Carolina, ____________________ County.
This is to certify that on the __________ day of ___________, ________, before me personally came ___________ (president, vice-president, secretary or assistant secretary, as the case may be), with whom I am personally acquainted, who, being by me duly sworn, says that _________ is the president (or vice-president), and __________ is the secretary (or assistant secretary) of the________, the corporation described in and which executed the foregoing instrument; that he knows the common seal of said corporation; that the seal affixed to the foregoing instrument is said common seal, and the name of the corporation was subscribed thereto by the said president (or vice-president), and that said president (or vice-president) and secretary (or assistant secretary) subscribed their names thereto, and said common seal was affixed, all by order of the board of directors of said corporation, and that the said instrument is the act and deed of said corporation. Witness my hand and (when an official seal is required by law) official seal, this the _________ day of __________ (year).
(Official seal.)
(Signature of officer.)
(d) If the deed or other instrument is executed by the signature of the president, vice-president, presiding member or trustee of the corporation, and sealed with its common seal and attested by its secretary or assistant secretary, the following form of proof and certificate thereof shall be deemed sufficient:
This ____ day of ____, A.D. ____, personally came before me (here give name and official title of officer who signs the certificate) A.B., who, being by me duly sworn, says that he is president (vice-president, presiding member or trustee) of the ____ Company, and that the seal affixed to the foregoing (or annexed) instrument in writing is the corporate seal of said company, and that said writing was signed and sealed by him in behalf of said corporation by its authority duly given. And the said A.B. acknowledged the said writing to be the act and deed of said corporation.
(Official seal.)
(Signature of officer.)
(e) All corporate conveyances probated and recorded prior to February 14, 1939, wherein the same was attested by the assistant secretary, instead of the secretary, and otherwise regular, are hereby validated as if attested by the secretary of the corporation.
(f) The following forms of probate for contracts in writing for the purchase of personal property by corporations providing for a lien on the property or the retention of a title thereto by the vendor as security for the purchase price or any part thereof, or chattel mortgages, chattel deeds of trust, and conditional sales of personal property executed by a corporation shall be deemed sufficient but shall not exclude other forms of probate which would be deemed sufficient in law:
(Signature of officer.)
(g) All deeds and other conveyances executed on or before April 12, 1974, by the president, any vice-president, assistant vice-president, manager, comptroller, treasurer, assistant treasurer, trust officer or assistant trust officer, or chairman or vice-chairman of a corporation are hereby validated to the extent that such deeds or other conveyances were otherwise properly executed, probated, and recorded.
(h) The forms of probate set forth in this section may be modified and adopted for use in the probate of deeds and other conveyances and instruments executed by entities other than corporations, including general and limited partnership, limited liability companies, trusts, and unincorporated associations. This subsection applies to notarial certificates and forms of probate made before, on, or after December 1, 2005. (1991, c. 647, s. 5; 1991 (Reg. Sess., 1992), c. 1030, s. 14; 1999-456, s. 59; 2006-59, s. 30.)
All documents, including but not limited to deeds, deeds of trust, and mortgages, required or permitted by law to be executed by corporations, shall be legally valid and binding when a legible corporate stamp which is a facsimile of its seal is used in lieu of an imprinted or embossed corporate seal. (1971, c. 340, s. 1.)
§ 47-41.2. Technical defects.
(a) Technical defects, including technical defects under G.S. 10B-68, and errors or omissions in a form of probate or other notarial certificate, shall not affect the sufficiency, validity, or enforceability of the form of probate or the notarial certificate or the related instrument or document. A register of deeds may not refuse to accept an instrument or document for registration because of technical defects, errors, or omissions in a form of probate or other notarial certificate.
(b) This section does not apply to the requirements for registration contained in G.S. 47-14(a) and a register of deeds shall not accept for registration an instrument that does not comply with the requirements of G.S. 47-14(a). (2006-59, s. 31; 2006-199, s. 3; 2013-204, s. 1.17.)
§ 47-42. Attestation of bank conveyances by secretary or cashier.
(a) Repealed by Session Laws 2002-26, s. 1.
(b) All deeds and conveyances executed prior to February 14, 1939, by banking corporations, where the cashier of said banking corporation has attested said instruments, which deeds and conveyances are otherwise regular, are hereby validated.
(c) All deeds and conveyances executed by a banking corporation on or after October 1, 1999, that complied with G.S. 47-18.3 are hereby validated. (1939, c. 20, s. 21/2; 1957, c. 783, s. 4; 2002-26, s. 1.)
§ 47-43. Form of certificate of acknowledgment of instrument executed by agent.
When an instrument purports to be signed by parties acting through another by virtue of the execution of a power of attorney, the following form of certificate is sufficient, but does not exclude other forms:
North Carolina, ______ County.
I (here give name of the official and the official's title), do hereby certify that (here give name of agent) (the "Agent"), agent for (here give names of parties who executed the instrument through the Agent) (the "Principal"), personally appeared before me this day, and being by me duly sworn, says that the Agent executed the foregoing and annexed instrument for and on behalf of the Principal, and that the Agent's authority to execute and acknowledge the instrument is contained in an instrument duly executed, acknowledged, and recorded in the office of (here insert name of official in whose office power of attorney is recorded, and the county and state of recordation), on the (day of month, month, and year of recordation), and that this instrument was executed under and by virtue of the authority given by the instrument granting the Agent power of attorney; that the Agent acknowledged the due execution of the foregoing and annexed instrument for the purposes therein expressed for and in behalf of the Principal.
WITNESS my hand and official seal, this ____ day of ______, (year) ____.
(Official seal.)
________________________
Signature of Officer
(1941, c. 238; 2018-142, s. 34.)
§ 47-43.1. Execution and acknowledgment of instruments by attorneys or attorneys-in-fact.
When an instrument purports to be executed by parties acting through another by virtue of a power of attorney, it shall be sufficient if the attorney or agent signs such instrument either in the name of the principal by the attorney or agent or signs as attorney or agent for the principal; and if such instrument purports to be under seal, the seal of the agent shall be sufficient. (1949, c. 66, s. 1; 2017-153, s. 2.3.)
§ 47-43.2. Officer's certificate upon proof of instrument by subscribing witness.
When the execution of an instrument is proved by a subscribing witness as provided by G.S. 47-12, the certificate required by G.S. 47-13.1 shall be in substantially the following form:
STATE OF______________________________________
(Name of state)
_______________________________________COUNTY
I, ______________________________, a ___________________________________
(Name of officer taking proof) (Official title of officer taking proof)
of _______________________COUNTY, ___________________________, certify that
(Name of state)
_______________________________________ personally appeared before me this day,
(Name of subscribing witness)
and being duly sworn, stated that in his presence ________________________________
(Name of maker)
(signed the foregoing instrument) (acknowledged the execution of the foregoing instrument.) (Strike out the words not applicable.)
WITNESS my hand and official seal, this the __________ day of________________,
(Month)
________
(Year)
(Signature of officer taking proof)
(Official title of officer taking proof)
My commission expires
(Date of expiration of officer's commission)
Provided, however, that when instruments have been recorded upon proof of execution of the instrument by certificate of a judicial officer, showing that execution was proven by oath and examination of the subscribing witness, the date of such examination, and the signature of the officer taking the proof, such proof of execution shall be deemed sufficient on all instruments filed for registration prior to March 15, 1961. (1951, c. 379, s. 3; 1953, c. 1078, s. 3; 1955, c. 1345, s. 6; 1961, c. 237; 1999-456, s. 59.)
§ 47-43.3. Officer's certificate upon proof of instrument by proof of signature of maker.
When the execution of an instrument is proved by proof of the signature of the maker as provided by G.S. 47-12.1 or as provided by G.S. 47-13, the certificate required by G.S. 47-13.1 shall be in substantially the following form:
STATE OF______________________________________________
(Name of state)
_________________________________________ COUNTY
I, _______________________________, a __________________________________
(Name of officer taking proof) (Official title of officer taking proof)
of___________________ COUNTY, _______________________________, certify that
(Name of state)
_______________________________________ personally appeared before me this day,
(Name of person familiar with
maker's handwriting)
and being duly sworn, stated that he knows the handwriting of______________________
(Name of maker)
and that the signature to the foregoing instrument is the signature of _________________
(Name of maker)
WITNESS my hand and official seal, this the ____ day of _________________, ____
(Month) (Year)
(Signature of officer taking proof)
(Official title of officer taking proof)
My commission expires
(Date of expiration of officer's commission)
(1951, c. 379, s. 3; 1999-456, s. 59.)
§ 47-43.4. Officer's certificate upon proof of instrument by proof of signature of subscribing witness.
When the execution of an instrument is proved by proof of the signature of a subscribing witness as provided by G.S. 47-12.1, the certificate required by G.S. 47-13.1 shall be in substantially the following form:
STATE OF________________________________________
(Name of state)
_________________________________________ COUNTY
I, ____________________________, a ______________________________________
(Name of officer taking proof) (Official title of officer taking proof)
of ___________________ COUNTY, _______________________________, certify that
(Name of state)
____________________________________ personally appeared before me this day, and
(Name of person familiar with
handwriting of subscribing witness)
being duly sworn, stated that he knows the handwriting of ________________________,
(Name of subscribing witness)
and that the signature of __________________________ as a subscribing witness to the
(Name of subscribing witness)
foregoing instrument is the signature of _______________________________________
(Name of subscribing witness)
WITNESS my hand and official seal, this the ____ day of ______________, ________
(Month) (Year)
(Signature of officer taking proof)
(Official title of officer taking proof)
My commission expires _________________________________________________
(Date of expiration of officer's commission)
(1951, c. 379, s. 3; 1999-456, s. 59.)
§ 47-44. Clerk's certificate upon probate by justice of peace or magistrate.
When the proof or acknowledgment of any instrument is had before a justice of the peace of some other state or territory of the United States, or before a magistrate of this State, but of a county different from that in which the instrument is offered for registration, the form of certificate as to his official position and signature shall be substantially as follows:
North Carolina _____________ County.
I, A.B. (here give name and official title of a clerk of a court of record), do hereby certify that C.D. (here give the name of the justice of the peace or magistrate taking the proof, etc.), was at the time of signing the foregoing (or annexed) certificate an acting justice of the peace or magistrate in and for the county of ________ and State (or territory) of_______________,
and that his signature thereto is in his own proper handwriting.
In witness whereof, I hereunto set my hand and official seal, this_____ day of______________, A.D. ______
(Official seal.)
(Signature of officer.)
(1899, c. 235, s. 8; Rev., s. 1006; C.S., s. 3327; 1971, c. 1185, s. 15.)
§ 47-45. Clerk's certificate upon probate by nonresident official without seal.
When the proof or acknowledgment of any instrument is had before any official of some other state, territory or country and such official has no official seal, then the certificate of such official shall be accompanied by the certificate of a clerk of a court of record of the state, territory or country in which the official taking the proof or acknowledgment resides, of the official position and signature of such official; such certificate of the clerk shall be under his hand and official seal and shall be in substance as follows:
____________County.
I, A.B. (here give name and official title of the clerk of a court of record as provided herein), do hereby certify that C.D. (here give name of the official taking the proof, etc.) was at the time of signing the foregoing (or annexed) certificate (here give the official title of the officer taking proof, etc.) in and for the county of ______ and state of ________ (or other political division of the state, territory or country, as the case may be), and that his signature thereto is in his own proper handwriting.
In witness whereof, I hereunto set my hand and official seal, this ______________day of______________, A.D.______
(Official seal.)
(Signature of Clerk.)
(1899, c. 235, s. 8; Rev., s. 1007; C.S., s. 3328.)
§ 47-46: Repealed by Session Laws 2005-123, s. 4, effective October 1, 2005.
§ 47-46.1. Notice of satisfaction of deed of trust, mortgage, or other instrument.
No particular phrasing is required for a notice of satisfaction pursuant to G.S. 45-37(a)(5) as it was prior to October 1, 2005, a satisfaction of a security instrument under G.S. 45-36.10, or a trustee's satisfaction under G.S. 45-36.20. The following form, when properly completed, is sufficient to satisfy the requirements (i) for a notice of satisfaction under G.S. 45-37(a)(5) as it was in effect prior to October 1, 2005, (ii) for a satisfaction under G.S. 45-36.10 if the form is signed and acknowledged by the secured creditor, and (iii) for a trustee's satisfaction under G.S. 45-36.20 if the security instrument is a deed of trust and the form is signed and acknowledged by the trustee:
North Carolina, ____________ County.
I, ____________ (name of trustee or mortgagee), certify that the debt or other obligation in the amount of ________ secured by the (deed of trust)(mortgage)(other instrument) executed by ____________ (grantor)(mortgagor), ____________ (trustee)(leave blank if mortgage), and ____________ (beneficiary)(mortgagee), and recorded in ____________ County at ________ (book and page) was satisfied on ____________ (date of satisfaction).
(Signature of trustee or mortgagee)
(Acknowledgment before officer authorized to take acknowledgments)
My commission expires ____________ (Date of expiration of official's commission).
(1987, c. 405, s. 2; c. 662, s. 4; 1989, c. 434, s. 2; 2005-123, s. 5; 2006-264, s. 82(a).)
§ 47-46.2. Certificate of satisfaction of deed of trust, mortgage, or other instrument.
No particular phrasing is required for a certification of satisfaction pursuant to G.S. 45-37(a)(6) as it was in effect prior to October 1, 2005, or for a satisfaction of a security instrument under G.S. 45-36.10. The following form, when properly completed, is sufficient to satisfy the requirements (i) for a certificate of satisfaction under G.S. 45-37(a)(6) as it was in effect prior to October 1, 2005, and (ii) for a satisfaction of a security instrument under G.S. 45-36.10 when signed and acknowledged by the secured creditor:
CERTIFICATE OF SATISFACTION
North Carolina, ____________ County.
I, ____________ (name of owner of the note or other indebtedness secured by the deed of trust or mortgage), certify that I am the owner of the indebtedness secured by the hereafter described deed of trust or mortgage and that the debt or other obligation in the amount of __________ secured by the (deed of trust)(mortgage)(other instrument) executed by ____________ (grantor)(mortgagor),
____________ (trustee)(leave blank if mortgage), and ______________ (beneficiary)(mortgagee), and recorded in __________ County at ______ (book and page) was satisfied on ____________ (date of satisfaction). I request that this certificate of satisfaction be recorded and the above-referenced security instrument be canceled of record.
(Signature of owner of note)
[Acknowledgment before officer authorized to take acknowledgments]. (1995, c. 292, s. 3; 2005-123, s. 5; 2006-226, s. 27(a); 2006-264, s. 82(a).)
§ 47-46.3. Affidavit of lost note.
No particular phrasing is required for an affidavit of lost note pursuant to G.S. 45-36(a)(6) as it was in effect prior to October 1, 2005. The following form, when properly completed, is sufficient to satisfy the requirements for an affidavit of lost note under G.S. 45-37(a)(6) as it was in effect prior to October 1, 2005.
AFFIDAVIT OF LOST NOTE
[Name of affiant] personally appeared before me in ____________ County, State of
____________, and having been duly sworn (or affirmed) made the following affidavit:
1. The affiant is the owner of the note or other indebtedness secured by the deed of trust, mortgage, or other instrument executed by __________ (grantor, mortgagor), __________ (trustee), and ____________ (beneficiary, mortgagee), and recorded in __________ County at __________ (book and page); and
2. The note or other indebtedness has been lost and after the exercise of due diligence cannot be located.
3. The affiant certifies that all indebtedness secured by the deed of trust, mortgage, or other instrument was satisfied on __________, __________ (date of satisfaction), and the affiant is responsible for cancellation of the same.
____________________
(Signature of affiant)
Sworn to (or affirmed) and subscribed before me this ____ day of ___________,_____.
[Signature and seal of notary public or other official authorized to administer oaths]. (1995, c. 292, s. 4; 1995 (Reg. Sess., 1996), c. 604, s. 2; c. 742, s. 19; 1999-456, s. 59; 2005-123, s. 6.)