Complete and sign the sworn statement in item 4 in front of the notary public. Request the notary acknowledge your signature in the sworn statement in item 4.The certificate of acknowledgment (PDF) must be in the form set forth in California Civil Code section 1189. Death Record Application Form. Section 5 — Certificate of Acknowledgment must be notarized if mailing. If you are claiming funds, please complete the following: Fill out both the Claim Affirmation Form and Claim for Money Held Form. Below Are A Few Example of Acknowledgement Notes That You Can Use. Contra Costa County Trustee Deed Form. Fill in the blank form formatted to comply with all recording and content requirements. The Contra Costa County Vital Registration Office is able to provide certified copies for births occurring this year and last year in Contra Costa County.