AFFIDAVIT OF NOTARY PRESENTMENT

CERTIFICATION OF MAILING

State State )
) ss.
County County )

On this _________day of Month, 2023, for the purpose of verification, I, the undersigned Notary Public, being
commissioned in the County and State noted above, do certify that First Middle Last appeared before me with
the following documents listed below. I, the undersigned Notary, personally verified that these documents were
placed in an envelope and sealed by me. They were sent by United States Post Office Certified Mail receipt
number 1234 1234 1234 1234 1234 to the President of the United States/PRESIDENT OF THE UNITED
STATES.

Document Number of Pages

1. AFFIDAVIT OF NOTARY PRESENTMENT/CERTIFICATION OF MAILING 1

2. RECORDED CLAIM OF COMMERCIAL LIEN AND CONDITIONAL ACCEPTANCE 1
3. CERTIFICATE OF DEFAULT 2

WITNESS my hand and official seal.

___________________________________ ________________
NOTARY PUBLIC DATE

My commission expires: _________________________, 20_______