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Office of the Secretary of the State State of Connecticut PO Box 150470, Hartford, CT 06115-0470

Notary Public Unit

JURAT AND WRITING SAMPLE

Please respond to the following in your own handwriting below. Question 1: Write out the complete form of acknowledgment for either an individual or a corporation. Question 2: Write out the form that a notary public would complete, when a sworn statement (affidavit) is made. Question 3: Write out the oath administered to a notary public. Question 4: Describe the ceremony of administering an oath. This document must be subscribed and sworn to on the last page. You may use additional paper if necessary. A completed Jurat and Writing Sample must be uploaded during the online application process.