State Form 45664 - Application For Real Estate Appraiser Permit For Temporary Practice Page 2
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1
2NOTARY CERTIFICATE
STATE OF ________________________________________________
SS:
COUNTY OF ________________________________________________
I, _______________________________________________, first being duly sworn on oath, say that I am the above-named applicant, that I have personally
prepared the foregoing application, and that the same is true to the best of my knowledge and belief.
Signature of applicant
Signature of Notary Public
Printed or typed name of applicant
Printed or typed name of Notary Public
Date subscribed and sworn to Notary Public
County of residence
Date commission expires
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