Notary Acknowledgement Form 2015 Example
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The notarized signature of the majority representative owner or owners, as established by deed or contract, of the
subject property or properties is required for the filing of this application. (Additional sheets may be attached.)
State of California
County of _________________________
On ___________________________ before me, _______________________________,
personally
NOTARY PUBLIC
(DATE)
(HERE INSERT NAME AND TITLE OF THE OFFICER)
appeared _________________________________________________________________________________________,
NAME(S) OF SIGNER(S)
who proved to me on the basis of satisfactory evidence to be the person(s) who name(s) is/are subscribed to the within
instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and
that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s)
acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and
correct.
WITNESS my hand and official seal.
_____________________________________________
(SIGNATURE)
(PLACE NOTARY SEAL ABOVE)
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.
D e s c r i p t i o n o f A t t a c h e d D o c u m e n t
Title of type of Document:
HISTORICAL PROPERTY CONTRACT
Document Date: __________________________________
Number of Pages __________________________________
Signer(s) Other Than Named Above: ____________________________________________________________________
C a p a c i t y ( i e s ) C l a i m e d b y S i g n e r ( s )
Signer’s Name: __________________________________
Signer’s Name: ____________________________________
Individual
Individual
Officer
Corporate Officer
Title(s): _____________________________________
Title(s): ________________________________________
Partner —
Limited General Partner
Partner —
Limited General Partner
Attorney-in-Fact
Attorney-in-Fact
Trustee
Trustee
Guardian or Conservator
Guardian or Conservator
Other: _______________________________________
Other: ________________________________________
Signer is Representing:
Signer is Representing:
______________________________________________
_________________________________________________
HISTORICAL PROPERTY CONTRACT APPLICATION
REVISED JANUARY 2015
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