Notarycertificateofdishonor TEMPLATE

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Republic of Your State ) NOTARY CERTIFICATE OF

) DISHONOR AND
) NON-RESPONSE
) SS
)
Example County )

PRESENTMENT

Be it known, that a duly empowered Notary Public, in and for the STATE OF NOTARY STATE,
COUNTY OF NOTARY COUNTY, a third party and not a party to the matter, at the request of Principal
/ Secured Party, did present on Original Notice Mailing Date, 2023, a DOCUMENT NAME pursuant to
international commercial law listed within the Notary Certificate of Service via Certified Mail with a
Return Receipt to:

ATT’N: C.F.O. for


COMPANY NAME HERE
1234 THEIR ADDRESS ST.
CITY, ST 12345
Respondent / LIBELLEE

The Secured Party sent a Notice requiring Respondent /LIBELLEE to issue a timely rebuttal regarding
the allegations in Claim No. Original Certified / Registered Mail #, and the time limit has elapsed,
constituting acceptance by Respondent / LIBELLEE thereof instead of providing a timely response /
rebuttal to the allegations of the Secured Party. An unrebutted Affidavit stands as the judgment in
commerce.

PROTEST

Whereupon, the Notary Public signing below, for the purpose and reason of Dishonor and Non-Response
does publicly and solemnly certify the dishonor as against all parties it may concern for liability
equivalent to the face value of the instrument and the claim of the debt, and all costs, late fees, damages
and interest incurred, or hereafter incurred, by reason of non-performance thereof and stipulations
therein.

NOTICE

The undersigned Notary Public certifies that on the _ day of Month, 2023, this Notice of Dishonor
was sent to Respondent by depositing said document with the USPS, Certified Mail No. Current Certified
Mail # with a Return Receipt Requested.

TESTIMONY

In testimony of the above, I have hereunto signed my name as a Notary Public and a non-interested third-
party witness.

My Commission Expires:__________________
Notary Name, Notary Public
c/o 1234 Notary Address St.
City, State [12345]

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