If the subscribing witnesses appear before the clerk or deputy clerk of any county of the state, and prove the facts necessary to authenticate the instrument, the clerk shall write on the back or some other part of the instrument the following certificate:

State of Tennessee )

County of ______________ )

Personally appeared before me, ______________, clerk (or deputy clerk) of the county of ______________ aforementioned, ______________ and ______________, subscribing witnesses to the within deed, who, being first sworn, deposed and said that they are acquainted with ______________, the bargainor (or as the case may be), and that the bargainor acknowledged the same, in their presence, to be the bargainor’s act and deed upon the day it bears date (or stating the time as proved by the witnesses).

Witness my hand, at office, this ______day of ______________, 20_____.