Sample New York State Notary Public Acknowledgment Form

STATE OF NEW YORK
COUNTY OF ___________________

On the _____ day of _______________, 20__, before me, the undersigned, a Notary Public in and for said State, personally appeared
__________________________________________
personally known to me or proved to me on the basis of satisfactory evidence to be the individual(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 capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument.

WITNESS my hand and official seal.

__________________________________________
Notary Public
Print Name: ______________________________
Notary Public, State of New York
No. _____________________________________
Qualified in ________________ County
Commission Expires: ______________________

Note: This is a template. Notaries must follow current NYS Executive Law §137 and Department of State guidelines. Always verify latest form requirements.