Below is the official Connecticut Acknowledgment Wording. The Notary must affix his/her stamp below the verbiage in this form to complete the notarial procedure.

State of Connecticut County of ______________ ss. (Town/City) On this the_____day of____________, 20____, before me, (name of notary) , the undersigned officer, personally appeared (name of individual or individuals), known to me (or satisfactorily proven) to be the person(s) whose name(s) (is or are) subscribed to the within instrument and acknowledged that (he, she or they) executed the same for the purposes therein contained. In witness whereof I hereunto set my hand. ______________________ Signature of Notary Public Date Commission Expires:_____________ ______________________ Printed Name of Notary