Notarized Identity Verification

State of _____________________________	)			
		                                	)  ss.	
County of ___________________________	)

I hereby certify that on this ______day of ________________________, 20___, for verification purpose, that I, the undersigned Notary Public, being commissioned in the County and State noted above, do certify that John Lee Doe personally appeared before me, the signer and subject of the document listed below, signed or attested to the same in my presence, and presented the following form of identification as proof of his or her identity: 

•	Driver’s License or Govt. Identification Card 
•	U.S. Passport U.S. Military ID Card 
•	State Identification Card 
•	Social Security Card 
•	Birth Certificate 
•	Other: _______________________________________________________________                                                  
    			(provide description)  

Document 									Number of Pages

“Oath of Office” for the Township level Public-Office of “Qualified Elector” 	   3

Notary Public: ____________________________________________	 
My Commission Expires: ____________________________________ 
Notary Public Signature: ____________________________________ 

       Reserved for Notary Seal