A notary shall use a certificate in substantially the following form in notarizing a signature or mark to confirm that it was affixed in the notary’s presence without administration of an oath or affirmation:
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 proven 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.
(official signature and seal of notary)History: 2008, PL 30-18.