Vermont Statutes
Chapter 103 - Notaries Public
§ 5368. Short-form certificates

§ 5368. Short-form certificates
The following short-form certificates of notarial acts shall be sufficient for the purposes indicated, if completed with the information required by subsections 5367(a) and (b) of this chapter:
(1) For an acknowledgment in an individual capacity:
State of Vermont [County] of _________________________________________
This record was acknowledged before me on ______ by ______
Date ____ Name(s) of individual(s)_________________________________________
Signature of notary public _________________________________________
Stamp____ [__________ ]
Title of office______ [My commission expires: ______ ]
(2) For an acknowledgment in a representative capacity:
State of Vermont [County] of _________________________________________
This record was acknowledged before me on ____ by ______
Date ____ Name(s) of individual(s) ______ as ______ (type of authority, such as officer or trustee) of ______ (name of party on behalf of whom record was executed).
Signature of notary public _________________________________________
Stamp [____________ ]
Title of office ______ [My commission expires: ______ ]
(3) For a verification on oath or affirmation:
State of Vermont [County] of _________________________________________
Signed and sworn to (or affirmed) before me on ______ by _________________________________________
Date ______
Name(s) of individuals making statement _________________________________________
Signature of notary public _________________________________________
Stamp [____________ ]
Title of office______ [My commission expires: ______ ]
(4) For attesting a signature:
State of Vermont [County] of _________________________________________
Signed [or attested] before me on ______ by _________________________________________
Date ____ Name(s) of individual(s) _________________________________________
Signature of notary public _________________________________________
Stamp [____________ ]
Title of office ______ [My commission expires: ______ ]
(5) For certifying a copy of a record:
State of _______________________________________
County of _______________________________________
I certify that this is a true and correct copy of a record in the possession of _______________________________________
Dated _________________________________________
Signature of notarial officer _______________________________________________________________________
Stamp___________
Title of office _______________________________________ [My commission expires: ___________ ]

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