An official State of Kansas government website.

Government Website icon

The .gov means it's official.
A .gov website belongs to an official government organization in the United States.

Padlock icon

The site is secure.
The https:// or lock icon ensures you're safely connected to the website and any information you provide is encrypted.

Publications iconKansas Administrative Regulations

  • Facebook icon
  • X icon
  • YouTube icon
  • Instgram icon

Agency 7

Secretary of State

Article 43.—Notaries Public

Previous   Next
7-43-17. Short form notarial certificates; statement for notarial act for a remotely located individual. (a) The following short form notarial certificates shall be sufficient for the purposes indicated, if completed in conformance with the procedures required for a notarial act:
(1) For an acknowledgment in an individual capacity:
"State of ________________________________________
County of ______________________________________

This record was acknowledged before me on
________ by ______________________________
Date Name(s) of person(s)
__________________________________
Signature of notarial officer

[Official Stamp]

__________________________________
Title of office

My commission expires: _________"

(2) For an acknowledgment in a representative capacity:
"State of _________________________________________
County of _______________________________________

This record was acknowledged before me on
________ by ______________________________
Date Name(s) of person(s)
as [type of authority, such as officer or trustee] of [name of party on behalf of whom record was executed].

__________________________________
Signature of notarial officer

[Official Stamp]

__________________________________
Title of office

My commission expires: _________"

(3) For a verification on oath or affirmation:
"State of _________________________________________
County of _______________________________________

Signed and sworn to (or affirmed) before me on
________ by ______________________________
Date Name(s) of person(s)
making statement
__________________________________
Signature of notarial officer

[Official Stamp]

__________________________________
Title of office

My commission expires: _________"

(4) For witnessing or attesting a signature:
"State of _________________________________________
County of _______________________________________

Signed (or attested) before me on
________ by ______________________________
Date Name(s) of person(s)
__________________________________
Signature of notarial officer

[Official Stamp]

__________________________________
Title of office

My commission expires: _________"

(5) For certifying a copy of a record:
"State of _________________________________________
County of _______________________________________
I certify that this is a true and correct copy of a record in the possession
of ________________________________________. Dated ___________________________

________________________________
Signature of notarial officer

[Official Stamp]

__________________________________
Title of office

My commission expires: _________"

(6) For power of attorney in a representative capacity:
"State of _________________________________________
County of _______________________________________

This instrument was signed before me on
________ by ______________________________
Date Name(s) of designee(s)
as power of attorney of
________________________________________
name of party on behalf of
whom instrument was executed.
_________________________________
Signature of notarial officer

[Official Stamp]

__________________________________
Title of office

My commission expires: _________"

(b) When a notary public performs a notarial act for a remotely located individual, the notarial certificate shall contain a statement substantially as follows: "This notarial act involved the use of audiovisual communication technology." (Authorized by K.S.A. 2022 Supp. 53-5a17; implementing K.S.A. 2022 Supp. 53-5a15 and 53-5a17; effective, T-7-6-30-22, June 30, 2022; effective Oct. 28, 2022; amended Dec. 29, 2023.)
Previous   Next
Secretary of State Seal