Notarial Request Form

Notarial Request Form

This Notarial Request Form is entered into as of Date: by and between Client Name: (Requestor) and Notary Name: (Notary).

RECITALS

WHEREAS, Requestor requires certain notarial acts to be performed on documents described herein and desires to engage Notary to perform such acts in accordance with applicable law;

WHEREAS, Notary is a duly commissioned notary public authorized to perform notarial acts within the jurisdiction stated in Notary Commission State: and agrees to perform such services under the terms and conditions set forth in this Form;

WHEREAS, the parties intend that this Form set forth the obligations, fees, representations and authorizations relating to the requested notarial acts;

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other valuable consideration, the parties hereby agree as follows:

1. SCOPE OF SERVICES

Notary shall perform the notarial acts requested by Requestor on the Document(s) described below and shall execute only those notarial certificates that comply with applicable law. Notary's obligations are limited to the performance of notarial acts and the completion of notarial certificates; Notary is not providing legal, tax, or immigration advice. Notary shall refuse to perform any notarial act if, in Notary's reasonable judgment, the requirements of law or the identity of the signer cannot be satisfactorily established.

2. DOCUMENTS TO BE NOTARIZED

Requested notarial acts (check all that apply):

Acknowledgment
Jurat (oath or affirmation)
Signature witnessing
Copy certification (where permitted)
Other:

3. IDENTIFICATION; PRESENCE

Requestor shall appear in person before Notary or participate via remote notarization if permitted and agreed. Requestor shall present identification acceptable to Notary. Type of identification presented: ID number: Issuing authority: Expiration date:

Remote notarization requested: Yes No

4. REQUESTOR REPRESENTATIONS AND WARRANTIES

Requestor represents and warrants that: (a) the Document(s) to be notarized are genuine and belong to the person(s) whose signature(s) will be notarized; (b) the signers are competent and acting voluntarily; (c) no signatory is under duress, incapacitated, or otherwise unfit to sign; and (d) Requestor has the authority to submit the Document(s) for notarization. Requestor will promptly inform Notary of any facts or circumstances that would affect the validity of the notarial act.

5. FEES AND PAYMENT

Payment is due at the time of service unless otherwise agreed. If Requestor cancels a scheduled appointment with less than 24 hours' notice, Requestor shall be responsible for a cancellation fee of Cancellation Fee: .

6. APPOINTMENT AND LOCATION

7. NOTARY OBLIGATIONS; COMPLIANCE

Notary shall perform notarial acts in compliance with the laws and regulations of Notary Commission State: . Notary shall complete appropriate notarial certificates, record entries in the notary journal as required by law and, where applicable, provide copies of notarial certificates to Requestor upon request and payment of any reasonable copying fee.

8. LIMITATION OF LIABILITY; INDEMNIFICATION

Notary's liability for errors, omissions or misconduct relating to the performance of notarial acts shall be limited to direct damages to the extent permitted by law. Notary shall not be liable for consequential, incidental, punitive or special damages. Requestor shall indemnify and hold Notary harmless from and against any claim, demand, loss, liability or expense (including reasonable attorneys' fees) arising out of false representations by Requestor, improper or fraudulent use of notarized documents, or Requestor's breach of this Form.

9. CONFIDENTIALITY

To the extent permitted by law, Notary will treat information contained in the Document(s) as private and will not disclose such information except as required by law, court order, or when necessary to perform the notarial act. Notary is not responsible for preserving confidentiality of information contained in documents if Requestor directs that copies be retained or distributed.

10. NOTARY COMMISSION INFORMATION

11. NOTICES

All notices shall be in writing and shall be deemed given when delivered personally or sent by first class mail or other commercially reasonable means to the addresses provided above.

12. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Form shall be governed by and construed in accordance with the laws of Governing State: , without regard to its conflicts of law rules. This Form constitutes the entire agreement between the parties with respect to its subject matter and supersedes all prior agreements and understandings, whether written or oral. If any provision of this Form is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

13. AMENDMENT; WAIVER; COUNTERPARTS

This Form may be amended only by a writing signed by both parties. No waiver of any provision shall be effective unless in writing signed by the party against whom enforcement is sought. This Form may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument.

14. ADDITIONAL INSTRUCTIONS

CERTIFICATIONS

Requestor certifies under penalty of perjury that the information provided in this Form is true and correct, that the Document(s) presented for notarization are genuine to Requestor's knowledge, and that Requestor authorizes Notary to perform the notarial acts described above and to make any entries in the notary journal required by law.

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