North Carolina General Statutes
Article 3 - Forms of Acknowledgment, Probate and Order of Registration.
§ 47-43.3 - Officer's certificate upon proof of instrument by proof of signature of maker.

47-43.3. Officer's certificate upon proof of instrument by proof of signature of maker.
When the execution of an instrument is proved by proof of the signature of the maker as provided by G.S. 47-12.1 or as provided by G.S. 47-13, the certificate required by G.S. 47-13.1 shall be in substantially the following form:
(Name of state)
I, _______________________________, a __________________________________
WITNESS my hand and official seal, this the ____ day of _________________, ____
__________________________________________
(Signature of officer taking proof)
__________________________________________
(Official title of officer taking proof)
My commission expires _______________________________________________________
(Date of expiration of officer's commission)
(1951, c. 379, s. 3; 1999-456, s. 59.)