BLANK JURAT FORM

State of California
County of ______________________ } ss.

Subscribed and sworn to (or affirmed) before me on on this __________________ day of _____________________, 20_____, by __________________________, proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.


HOW TO COMPLETE THE JURAT FORM

State of California
County of Place where document signer appeared } ss.

Subscribed and sworn to (or affirmed) before me on on this Day day of Month, 20Year , by Name(s) of person(s) who appeared, proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.

Notary Public Signature
Notary Public Seal Imprint


SAMPLE COMPLETED JURAT FORM

State of California
County of San Diego} ss.

Subscribed and sworn to (or affirmed) before me on this 1 day of January, 2000, by Frank Johnson, proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.

Bob Smith