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Page 4 of 5 Pages   Sequential Journal
 
Push Play for Introduction
 
Sequential Journal Headings

1.

DATE OF NOTARY SERVICE
MONTH:
DAY:
YEAR
TIME
AM
PM

2.

TYPE OF SERVICE
[ ] ACKNOWLEDGMENT
[ ] JURAT
[ ] SUBSCRIBING WITNESS
[ ] POWER OF ATTORNEY CERTIFICATION
[ ] SEQUENTIAL JOURNAL CERTIFICATION

 

3.

DOCUMENT DATE
MONTH:
DAY:
YEAR:
[ ] NO DOCUMENT DATE

 

4.

TYPE OR TITLE OF DOCUMENT
 
 
 
 
 
 
 
[ ] SIGNER STATED DOCUMENT IS COMPLETE
           PAGE (S) PRINTED ON                 SIDE(S)

 

5.

SIGNER IDENTIFICATION
ISSUING AGENCY                               TYPE OF I.D.
BIRTH DATE                                        EXPIRATION                  I.D. NUMBER
[ ] PERSONAL KNOWLEDGE                     [  ] ONE CREDIBLE WITNESS
[ ] SATISFACTORY EVIDENCE                   [ ] TWO CREDIBLE WITNESS
[ ] PRINCIPLE            [ ] ATTORNEY IN FACT    [ ] SUBSCRIBING WITNESS

 

6.

CURRENT ADDRESS
 
 
 
 
 

7.

ADDITIONAL INFORMATION
[ ] PLACED UNDER OATH
[ ] PLACED UNDER AFFIRMATION
 
 
 
 
 
 
 
 
[ ] ADDITIONAL INFORMATION CONTINUED ON PAGE:

 

8.

SIGNATURE


X
SIGNATURE



X
PRINT NAME

 

9.

FEE
SIGNATURE FEE

$
TRAVELING FEE

$
TIP

$

 

10.

THUMBPRINT
 
 
 
 
 
 
 
 
 
 
 

 

 

 

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3.

 

 
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Dennis L. Ryan is a writer and lecturer,  Judge Arbiter and  chairman of the appellate review board.

Vintage Press-In the Nest of the Eagles, published 1990 

Military Publications: Fleet Marine Corp Field Manuals: Counter Intelligence, CGW-Deception, Naval Warfare-Electronic Counter Measures

Library of Congress: United States Mediator, published 1995, United States Arbitrator, published 1997,