(Seal). Given under my hand and seal of office this _____ day of ______, 20____. (Notary's Signature).Form for Ordinary Certificate of Acknowledgment. (Personalized Seal). An acknowledgment is one of the most common types of notarial acts, but it often confuses Notaries. Here are 5 steps to performing an acknowledgment. MAIL THE APPLICATION, SWORN STATEMENT, PHOTOCOPY OF YOUR VALID PHOTO ID AND FEE TO: Mary Louise Nicholson, County Clerk. 200 Taylor St., Suite 301. To allow individuals to acknowledge they received a notice of an administrative disqualification hearing. By using the Services, you represent and warrant that you are of legal age to form a binding contract with us.