When the execution of an instrument is proved by a subscribing witness as provided by N.C. Gen. Stat. § 47-12, 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 subscribing witness)

and being duly sworn, stated that in his presence ________________________________

                                                                                                         (Name of maker)

(signed the foregoing instrument) (acknowledged the execution of the foregoing instrument.) (Strike out the words not applicable.)

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)

Provided, however, that when instruments have been recorded upon proof of execution of the instrument by certificate of a judicial officer, showing that execution was proven by oath and examination of the subscribing witness, the date of such examination, and the signature of the officer taking the proof, such proof of execution shall be deemed sufficient on all instruments filed for registration prior to March 15, 1961. (1951, c. 379, s. 3; 1953, c. 1078, s. 3; 1955, c. 1345, s. 6; 1961, c. 237; 1999-456, s. 59.)