Missouri Revised Statutes Title XXXII. Courts § 486.760. Signature form

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:

State of Missouri

County (and/or City) 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, 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 identification documents 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)