BLANK SUBSCRIBING WITNESS JURAT FORM

State of California
County of _______________} ss.

On _______________, before me, _______________, the undersigned, a notary public for the state, personally appeared _______________, personally known to me (or proved to me on the oath of _______________, who is personally know to me) to be the person whose name is subscribed to the within instrument, as a witness thereto, who, being by me duly sworn, deposed and said that he/she was present and saw/heard acknowledged ________________, the same person(s) described in and whose name(s) is/are subscribed to the within and annexed instrument in his/her/their authorized capacity(ies) as (a) party(ies) thereto, execute the same, and that said affiant subscribed his/her name to the within instrument as a witness at the request of _______________ .

WITNESS my hand and official seal.


HOW TO COMPLETE THE SUBSCRIBING WITNESS JURAT FORM

State of California
County of Place where Subscribing Witness appeared } ss.

On Date Subscribing Witness appeared , before me, Name of Notary Public , the undersigned, a notary public for the state, personally appeared Name of Subscribing Witness , personally known to me (or proved to me on the oath of Name(s) of Credible Witness , who is personally know to me) to be the person whose name is subscribed to the within instrument, as a witness thereto, who, being by me duly sworn, deposed and said that he/she was present and saw/heard acknowledged Name(s) of document principal(s) , the same person(s) described in and whose name(s) is/are subscribed to the within and annexed instrument in his/her/their authorized capacity(ies) as (a) party(ies) thereto, execute the same, and that said affiant subscribed his/her name to the within instrument as a witness at the request of Name(s) of document principal(s) .

WITNESS my hand and official seal.

Notary Public Signature
Notary Public Seal Imprint


SAMPLE COMPLETED SUBSCRIBING WITNESS JURAT FORM

State of California
County of San Diego} ss.

On January 1, 2000, before me, Bob Smith, the undersigned, a notary public for the state, personally appeared Adam Johnson, personally known to me (or proved to me on the oath of __N/A___, who is personally know to me) to be the person whose name is subscribed to the within instrument, as a witness thereto, who, being by me duly sworn, deposed and said that he/she was present and saw/heard acknowledged Jim Jones, Robert Jones, the same person(s) described in and whose name(s) is/are subscribed to the within and annexed instrument in his/her/their authorized capacity(ies) as (a) party(ies) thereto, execute the same, and that said affiant subscribed his/her name to the within instrument as a witness at the request of Jim Jones, Robert Jones.

WITNESS my hand and official seal.

Bob Smith