A notary shall use a jurat certificate in substantially the following form in notarizing a signature or mark on an affidavit or other sworn or affirmed written declaration:
Territory of American Samoa
County of __________________
On this _________ day of ________________, 20________, before me, the undersigned notary, personally appeared ______________________ (name of document signer),
(personally known to me)
(proved to me through identification documents allowed by law, which were _________________,)
(proved to me on the oath or affirmation of ______________, who is personally known to me and stated to me that (he) (she) personally knows the document signer and is unaffected by the document,)
(proved to me on the oath or affirmation of ______________ and ______________, whose identities have been proved to me through documents allowed by law and who have stated to me that they personally know the document signer and are unaffected by the document,)
to be the person who signed the preceding or attached document in my presence and who swore or affirmed to me that the contents of the document are truthful and accurate to be best of (his)(her) knowledge and belief.
(official signature and seal of notary)History: 2008, PL 30-18.