When the execution of an instrument is proved by proof of the signature of the maker as provided by N.C. Gen. Stat. § 47-12.1 or as provided by N.C. Gen. Stat. § 47-13, the certificate required by N.C. Gen. Stat. § 47-13.1 shall be in substantially the following form:

 

STATE OF______________________________________________

(Name of state)

_________________________________________ COUNTY

I, _______________________________, a __________________________________

                                      (Name of officer taking proof)                    (Official title of officer taking proof)

of___________________ COUNTY, _______________________________, certify that

                                                                                       (Name of state)

_______________________________________ personally appeared before me this day,

                     (Name of person familiar with

                              maker’s handwriting)

and being duly sworn, stated that he knows the handwriting of______________________

                                                                                                                  (Name of maker)

and that the signature to the foregoing instrument is the signature of _________________

                                                                                                                        (Name of maker)

WITNESS my hand and official seal, this the ____ day of _________________, ____

                                                                                                                  (Month)                 (Year)

                                                                        __________________________________________

                                                                              (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.)