Notary Certificate of Dishonor
I. Prepared By
The document referred to as the Notary Certificate of Dishonor has been thoroughly prepared by [Your Name]. I hold the position and carry the responsibilities of a notary public, duly commissioned, and fully licensed as per the legislative requirements. My current place of residence is in the city of [Your Company Address] which is located within the boundaries of the state of [State].
II. Certificate Details
Certificate Number: [Certificate Number]
Date of Issuance: [Date of Issuance]
Issuing Authority: [Your Company Name]
Jurisdiction: [Jurisdiction]
III. Certificate Recipient
This Notary Certificate of Dishonor is issued to:
IV. Instrument Details
Type of Instrument: Check
Instrument Number/Identifier: 56789123
Date of Instrument: April 12, 2050
Amount: $1,250.75
V. Reason for Dishonor
The instrument described above has been presented for payment and has been dishonored due to:
VI. Notary Attestation
I, [Your Name], as a duly appointed and currently active Notary Public, am the individual who is undersigned on this document. I solemnly and forthrightly certify, and this is under the potential penalties associated with perjury, that all of the information provided herein, also referred to as the 'foregoing', is true and correct to the best extent of my current knowledge and deeply held belief.
VII. Notary Acknowledgment
On this [Date of Notarization], before me, [Your Name], a Notary Public, personally appeared [Your Name], known to me (or proved to me based on satisfactory evidence) to be the person whose name is subscribed to the within instrument, and acknowledged to me that he/she executed the same in his/her authorized capacity and that by his/her signature on the instrument, the person, or entity upon behalf of which the person acted, executed the instrument.
VIII. Notary Seal and Signature
Printed Name of Client: [Client's Name]
Date: [Date Signed]
Printed Name of Notary Public: [Your Name]
Date: [Date Signed]
Notary Seal (if applicable): [Seal]
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