All Purpose Acknowledgment Form - State Of California
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1CALIFORNIA ALL PURPOSE ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity of the individual who
signed the document, to which this certificate is attached, and not the truthfulness, accuracy, or validity of
that document.
STATE OF CALIFORNIA
}
COUNTY OF _______________________}
On ___________________________before me , ________________________________________Notary
Date
Insert Name and Title of the officer
Public, personally appeared ______________________________________________________________
_____________________________________________________________________________________
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose 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: __________________________________
------------------------------------------------------------- OPTIONAL -------------------------------------------------------------
Though this section is optional, completing this information can deter alteration of the document or fraudulent
attachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: _______________________________Document Date:____________________
Number of Pages:__________ Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signers Name:______________________________ Signers Name:
Corporate Officer – Title(s)_________________
Corporate Officer – Title(s)___________________
Partner -
Limited
General
Partner -
Limited
General
Individual
Attorney in Fact
Individual
Attorney in Fact
Trustee
Guardian or Conservator
Trustee
Guardian or Conservator
Other:__________________________________
Other:
Signer is Representing:_______________________ Signer is Representing:
_________________________________________
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