The form for certificate of acknowledgment by any public officer or deputy thereof, or by any trustee, guardian, conservator, or personal representative is as follows:
State of ________
County of ________
On this the ________ day of ________, 20____, before me, ________, the undersigned officer, personally appeared ________, of the state, county or city as the case may be of ________, known to me or satisfactorily proven to be the person described in the foregoing instrument, and acknowledged that he executed the same in the capacity therein stated and for the purposes therein contained.
In witness whereof I hereunto set my hand and official seal.
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Title of officer.