Professional Documents
Culture Documents
In Support of
Indorsed Bill Payment
John Henry Doe, being duly sworn, does hereby solemnly declare:
STATE OF
)
)
ss.
COUNTY OF
)
On the ______ day of ____________________, 20____ A.D., before me, the above sig-
natory personally appeared before me and proved to me on the basis of satisfactory evi-
dence to be the person whose name is subscribed to the within instrument and acknowl-
edged to me that he or she executed the same in his or her authorized capacity and as a
free act and deed, and that by his or her signature on the instrument, the person or the en-
tity upon behalf of which the person acted, signed under oath or asseveration, and accepts
the truth thereof.
______________________________ __________________________
Notary name PRINTED Notary Signature Seal/Stamp
______________________________ __________________________
.................................................................................................................................
.......................
COVER LETTER TO COUNTY CLERK (leave 2-inch margin at top):
John H. Doe
100 Main Street
City, State 99999
TO:
___________ County Registrar
100 Main Street
City, State 99999
The enclosed documents, listed below, are provided for ENTRY into the
record, by special appearance, In Re: the matter of JOHN HENRY DOE.
Sincerely,
___________________________________________.
John Henry Doe
Christian Name Surname
Encl:
1. 12 USC 95a (accepted)
2. 12 USC 411 (accepted)
3. Affidavit in Support of Indorsed Bill Payment
4. Notary Certificate of Commission