2012 Kansas Statutes
Chapter 53 NOTARIES PUBLIC AND COMMISSIONERS
Article 5 NOTARIAL ACTS
Section 53-509 Short forms.

53-509. Short forms. The following short form certificates of notarial acts are sufficient for the purposes indicated, if completed with the information required by subsection (a) of K.S.A. 53-508:

(a) For an acknowledgment in an individual capacity:

State of ___________________________)

(County) of ________________________)

This instrument was acknowledged before me on (date) by [name(s) of person(s)]

_________________________________.

(Signature of notarial officer)

(Seal, if any)

_________________________________

Title (and Rank)

[My appointment expires: _______]

(b) For an acknowledgment in a representative capacity:

State of ___________________________

(County) of ________________________

This instrument was acknowledged before me on (date) by [name(s) of person(s)] as (type of authority, e.g., officer, trustee, etc.) of (name of party on behalf of whom instrument was executed.)

_________________________________

(Signature of notarial officer)

(Seal, if any)

_________________________________

Title (and Rank)

[My appointment expires: _______]

(c) For a verification upon oath or affirmation:

State of ___________________________

(County) of ________________________

Signed and sworn to (or affirmed) before me on (date) by [name(s) of person(s)] making statement].

_________________________________

(Signature of notarial officer)

(Seal, if any)

_________________________________

Title (and Rank)

[My appointment expires: ________]

(d) For witnessing or attesting a signature:

State of ___________________________

(County) of ________________________

Signed or attested before me on (date) by [name(s) of person(s)]

_________________________________

(Signature of notarial officer)

(Seal, if any)

_________________________________

Title (and Rank)

[My appointment expires: _______]

(e) For attestation of a copy of a document:

State of ___________________________

(County) of ________________________

I certify that this is a true and correct copy of a document in the possession of _______________________________.

Dated: ___________________

_________________________________ (Signature of notarial officer)

(Seal, if any)

_________________________________

Title (and Rank)

[My appointment expires: ________]

(f) For power of attorney in a representative capacity:

State of ___________________________

(County) of ________________________

This instrument was signed before me on (date) by [name(s) of designee(s)] as (power of attorney) of (name of party on behalf of whom instrument was executed.)

_________________________________ (Signature of notarial officer)

(Seal, if any)

_________________________________

Title (and Rank)

[My appointment expires: _______]