Notary Form for a Passport
City: ______________________________________ State: __________ Zip Code: ___________________________
I, the above listed passport bearer personally appeared before the undersigned notary public and under oath or affirmations do hereby make the following
I am the legal bearer of the presented United States Passport Number #: _________________________________,
Issued on: ___/___/_____ and having an expiration date of: ___/___/_____.
My date of birth is: ___/___/_____
I, hereby declare that the reproduction of this passport is a true, correct and complete photocopy of the passport that is in my possession and control.
Passport Bearerís Signature: ____________________________________________________ Date: ___/___/_____
State of: __________________________
County of: ________________________
The foregoing document was acknowledged before me this _________________ day of ______________________
20_____, at _____________________________________ in the State of: _________________________________
To be his or her free act of deed.
Signature of Notary Public: _______________________________________________________________________
My commission expires: ___/___/_____