Consular vital record search request form

State of ____________________ ) County of ___________________)
On ________________ before me, ________________________, notary public (here insert name and title of the officer), personally appeared ______________________________________ (here insert name of signer above), who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(capacities), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of ________________ that the foregoing paragraph is true and correct. WITNESS my hand and official seal. (SEAL)_____________________________________ ____________________________________
Notary Signature Commission Expires

Print this form. Additionally, only sign it in front of a notary.
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