ILLINOIS SAMPLE FORMS | Notary of America

ILLINOIS SAMPLE FORMS

 Acknowledgement

 Verification upon Oath or Affirmation

 Witnessing or Attesting a Signature

 Signature-by-Mark

An Illinois notary public is authorized to perform notarial acts or “notarization” anywhere in the state.

Notarial acts include taking an acknowledgment, taking a verification upon oath or affirmation, itnessing

or attesting a signature, administering an oath or affirmation, and performing any other act authorized by

law (Sec. 6-101).

A notary public must positively identify the person requesting notarization. A notary has positive

identification if the person (a) is personally known to the notary; (b) is identified upon the oath or

affirmation of a credible witness personally known to the notary; or (c) is identified on the basis of

identification documents (Sec. 6-102).

There is a certificate for each type of notarial act. Most documents have a preprinted certificate on the

form, or a certificate has been prepared by an attorney. It is not the notary’s function to determine what

type of notarial act is required with regard to a request, but the notary must know and use the proper

certificate for the type of act he or she is requested to perform (Sec. 6-103). A brief description of each

type of notarial act and the related certificate follows.

For additional information, please see the Illinois Notary Handbook

Acknowledgments

The taking of an acknowledgment consists of positively identifying the signer of a document. The signer

need not sign in the notary’s presence but must personally appear before the notary and state that the

signature on the document is his or hers. Acknowledgments may be taken in an individual capacity or in a

representative capacity (as an authorized representative of another – for example, as officer of a

corporation for and on behalf of the corporation or as an attorney in fact for another person). These short

form certificates are sufficient to meet the requirements of the law.

Acknowledgment (in an individual capacity):

State of Illinois

County of ___________________.

This instrument was acknowledged before me on _______________________________

(date) by ___________________________ (name of person).

(seal)

________________________

signature of notary public

Acknowledgment (in a representative capacity):

State of Illinois

County of ___________________.

This instrument was acknowledged before me on ______________________________

(date) by ___________________________ (name of person) as

________________________ (type of authority, e.g., officer, trustee, etc.) of

___________________________________ (name of party on behalf of whom

instrument was executed).

(seal)

________________________

signature of notary public

Verification Upon Oath of Affirmation

Sometimes referred to as a “jurat,” verification upon oath or affirmation is a declaration that a

statement is true and was made by a person upon oath or affirmation. The person requesting this

notarial act must personally appear before the notary and sign the document in the presence of

the notary. The notary public is required to administer an oath. There is no prescribed wording

for the oath, but an acceptable oath would be:

“Do You Swear (Or Affirm) That The Statements In This Document Are True?”

Verification upon oath may be taken in an individual capacity or in a representative

capacity. These short form certificates are sufficient to meet the requirements of

the law.

Verification upon oath or affirmation (in an individual capacity):

State of Illinois

County of ___________________.

Signed and sworn (or affirmed) to before me on _________________________ (date) by

___________________________ (name of person making statement).

(seal)

________________________

signature of notary public

Verification upon oath or affirmation (in a representative capacity):

State of Illinois

County of ___________________.

Signed and sworn (or affirmed) to before me on

_________________________________ (date) by _____________________________

(name of person) as __________________________ (type of authority, e.g., officer,

trustee, etc.) of _____________________________________ (name of party on behalf

of whom instrument was executed).

(seal)

________________________

signature of notary public

Witnessing or Attesting a Signature

Occasionally, a notary public may be requested to witness a signature on a document when no

oath is necessary or required. The person requesting this notarial act must personally appear

before the notary and sign the document in the presence of the notary. This short form certificate

is sufficient to meet the requirements of the law.

State of Illinois

County of ___________________.

Signed (or subscribed or attested) before me on _______________ (date) by

______________________________________________ (name of person).

(seal)

________________________

signature of notary public

Signature-by-Mark

When an individual requests a notarial act and the individual is prevented by disability or

illiteracy from writing a signature, take these precautions: positively identify the individual;

ensure that there are two persons to witness the signature-by-mark in addition to yourself; write

in the name of the signer-by-mark near the mark on the document, and complete the form below.

State of Illinois

County of ___________________.

This instrument was acknowledged before me on _________________ (date) by

________________________________________________(name of person) who made

and acknowledged making his/her mark on the instrument in my presence and in the

presence of two persons who have signed below.

(seal)

___________________________

signature of notary public

___________________________

signature and address of witness

___________________________

signature and address of witness

Oaths or Affirmations

On rare occasions, a notary may be asked to administer a verbal oath or affirmation. Illinois

notaries public are authorized to administer such oaths not only by the Notary Public Act but also

by other state laws (Illinois Revised Statutes, ch. 101). Notaries may administer oaths to

witnesses, the oath of office to public officials when an oath of office is required to be taken, and

oaths on any other occasion when an oath is required.

An oath contains the words, “I do solemnly swear . . . ,” and an affirmation contains the words,

“I do solemnly affirm . . . .” Either form may be used, as both are effective in invoking the

perjury statute against the maker of a false statement.

The exact wording of the oaths or affirmations can vary from situation to situation. It is not the

obligation of a notary to ascertain the proper wording of an oath or affirmation, but the notary

can administer it when the proper wording is provided. Following is a constitutional oath or

affirmation required to be taken by most elected state and local officials.

Oath or Affirmation:

“I do solemnly swear (affirm) that I will support the Constitution of the United

States, and the Constitution of the State of Illinois, and that I will faithfully discharge

the duties of the office of ________________________ to the best of my ability.”