The certificate of acknowledgment (PDF) must be in the form set forth in California Civil Code section 1189. Complete the notarization.Fill out, sign, and affix your official seal to the Notary certificate. Strictly speaking, a jurat is the words that the notary fills out which record the fact that a person took an oath. I acknowledge that I have been provided a copy of the Notice of Privacy Practices for the above named pediatric medical practice. Join three or more independent words to turn them into a complex compound word. 3. Emerging Store Manager. Address: 1376 KOOSER RD,SAN JOSE,CA,95118. When completing outside of a hospital or birthing center, parents must not complete the Registrar's sections at the top or bottom of the form. If you have completed this form in the past for this document, you will not be prompted to fill out this form.

Acknowledgement With Sign At Bottom In San Jose

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