Notary Form For 1583 Processing (Page 2 of 2) in pdf

Notary Form For 1583 Processing Page 2

Notary Form for 1583 Processing

(Please Print)

Name of Applicant #1: Doe_____________________John_________________________A_____

Last Name,

First Name,

Name of Applicant #2: ___________________________________________________________

Last Name,

First Name,

State of: Washington________

County of: Island __________

___ day of September_______, 20_14___, I attest that I have examined the identification

On this ___2

presented by the above named individual(s), and the documents presented appear to be genuine and relate to

the above named individual(s).

Documents which were presented:

Applicant #1

Applicant #2

ID #1: WA Drivers License__________________

ID #1: ___________________________________

ID No.: __________________________________

ID No.: DOE**JA123QA____________________

Exp. Date: _______________________________

Exp. Date: 08/12/2017_____________________

ID #2: ___________________________________

ID #2: Military ID__________________________

ID No.: __________________________________

ID No.: SSN_______________________________

Exp. Date: _______________________________

Exp. Date: 31July2016______________________

Jane R. Smith

Notary Signature:

_______________________

Printed Name: _Jane R. Smith___________________________

(Seal)

Date Commission Expires: _04/09/2017___________________

Additional Instructions for Applicant(s): Please attach legible photocopies of the examined documents and

send to this address:

Attn: Mailbox Manager

Pony Mailing & Business Center

316 SE Pioneer Way

Oak Harbor, WA 98277

Notary Form For 1583 Processing Page 2