Form 6100 "Assignor and Assignee Notary Page" - Arizona

What Is Form 6100?

This is a legal form that was released by the Arizona State Land Department - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2016;
  • The latest edition provided by the Arizona State Land Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 6100 by clicking the link below or browse more documents and templates provided by the Arizona State Land Department.

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Download Form 6100 "Assignor and Assignee Notary Page" - Arizona

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TO BE COMPLETED BY ASSIGNOR(S) A.K.A. SELLER(S)
CERTIFICATION: Pursuant to A.R.S. Title 37 and the Rules of the Arizona State Land Department, A.A.C. Title 12, Chapter 5, you must complete the following
information pertinent to you and sign the certification. NOTE: Applicant must complete item #1.
1.
Is this application made in the name of: (Applicant must check one)
____Individual(s)
____Husband & Wife
____Corporation
____Ltd. Liability Co.
____Partnership
____Ltd. Partnership
____Estate
____Trust
____Joint Venture
____Municipality
____Political Subdivision
____Other (specify) ___________________________________
2.
INDIVIDUAL(s) OR HUSBAND & WIFE: Complete the following for each applicant:
NAME
AGE
MARITAL STATUS
___________________________________________________________________________ ____________
_____________________________________
___________________________________________________________________________ ____________
_____________________________________
3.
CORPORATION: Complete the following:
(A) Do you have authority from the Arizona Corporation Commission to transact business in the State of Arizona?
Yes____ No____
(B) Is the corporation presently in good standing with the Arizona Corporation Commission?
Yes____ No____
(C) In what state are you incorporated? _____________________________________________________
(D) Is the legal corporate name and Arizona business address the same as stated in this application?
Yes____ No____
If no, state the Legal Corporate Name: __________________________________________________________________________________________
Address: ___________________________________________________________________________________________________________________
(Street or Box Number)
(City)
(State)
(Zip)
4.
LIMITED LIABILITY COMPANY: Complete the following:
(A) If an out-of-state limited liability company: Have you filed for a Certificate of Registration with the Arizona Corporation Commission?
Yes____ No____
(B) If an Arizona limited liability company: Have you filed Articles of Organization with the Arizona Corporation Commission?
Yes____ No____
(C) Are you authorized by the Arizona Corporation Commission to transact business in Arizona? Yes____ No____
5.
PARTNERSHIP OR JOINT VENTURE: Complete the following for each authorized partner or principal:
NAME
ADDRESS
AGE
MARITAL STATUS
_____________________________________________ _____________________________________________________ _______ _____________________
_____________________________________________ _____________________________________________________ _______ _____________________
6.
LIMITED PARTNERSHIP: Is this limited partnership on file with the Arizona Secretary of State? Yes____ No____
Complete the following for the authorized general partner(s) only:
GENERAL PARTNER(S) NAME
BUSINESS ADDRESS
___________________________________________________ _____________________________________________________________________________
___________________________________________________ _____________________________________________________________________________
7.
ESTATE: Complete the following and attach a copy of the court or estate document(s):
Name of the court appointed administrator or personal representative: _____________________________________________________________________
List the type and date of issuance of the court or Estate document:
(Type of Document)
(Date issued)
§
8.
TRUST: (A) Complete the following pursuant to A.R.S.
33-404, for each beneficiary of the Trust:
NAME
ADDRESS
AGE
MARITAL STATUS
_____________________________________________ ____________________________________________________ ________ _____________________
_____________________________________________ ____________________________________________________ ________ _____________________
or (B) Identify the Trust document by title, document number, and county where document is recorded: ________________________________________
9.
I HEREBY CERTIFY, UNDER PENALTY OF PERJURY, THAT THE INFORMATION AND STATEMENTS CONTAINED HEREIN, TOGETHER
WITH ALL EXHIBITS AND ATTACHMENTS ARE TRUE, CORRECT AND COMPLETE AND THAT I/WE HAVE AUTHORITY TO SIGN THIS
SIGNATURE(S)
DOCUMENT.
(Name of Corporation, Partnership, etc.)
Signature of Assignor (Individual, Trustee, Personal Representative, etc
Signature
Title
Signature of Assignor (Individual, Trustee, Personal Representative, etc)
(Signatures must be notarized on page 4)
6100-05/94 (Rev. 08/2016dw) Assign
3
TO BE COMPLETED BY ASSIGNOR(S) A.K.A. SELLER(S)
CERTIFICATION: Pursuant to A.R.S. Title 37 and the Rules of the Arizona State Land Department, A.A.C. Title 12, Chapter 5, you must complete the following
information pertinent to you and sign the certification. NOTE: Applicant must complete item #1.
1.
Is this application made in the name of: (Applicant must check one)
____Individual(s)
____Husband & Wife
____Corporation
____Ltd. Liability Co.
____Partnership
____Ltd. Partnership
____Estate
____Trust
____Joint Venture
____Municipality
____Political Subdivision
____Other (specify) ___________________________________
2.
INDIVIDUAL(s) OR HUSBAND & WIFE: Complete the following for each applicant:
NAME
AGE
MARITAL STATUS
___________________________________________________________________________ ____________
_____________________________________
___________________________________________________________________________ ____________
_____________________________________
3.
CORPORATION: Complete the following:
(A) Do you have authority from the Arizona Corporation Commission to transact business in the State of Arizona?
Yes____ No____
(B) Is the corporation presently in good standing with the Arizona Corporation Commission?
Yes____ No____
(C) In what state are you incorporated? _____________________________________________________
(D) Is the legal corporate name and Arizona business address the same as stated in this application?
Yes____ No____
If no, state the Legal Corporate Name: __________________________________________________________________________________________
Address: ___________________________________________________________________________________________________________________
(Street or Box Number)
(City)
(State)
(Zip)
4.
LIMITED LIABILITY COMPANY: Complete the following:
(A) If an out-of-state limited liability company: Have you filed for a Certificate of Registration with the Arizona Corporation Commission?
Yes____ No____
(B) If an Arizona limited liability company: Have you filed Articles of Organization with the Arizona Corporation Commission?
Yes____ No____
(C) Are you authorized by the Arizona Corporation Commission to transact business in Arizona? Yes____ No____
5.
PARTNERSHIP OR JOINT VENTURE: Complete the following for each authorized partner or principal:
NAME
ADDRESS
AGE
MARITAL STATUS
_____________________________________________ _____________________________________________________ _______ _____________________
_____________________________________________ _____________________________________________________ _______ _____________________
6.
LIMITED PARTNERSHIP: Is this limited partnership on file with the Arizona Secretary of State? Yes____ No____
Complete the following for the authorized general partner(s) only:
GENERAL PARTNER(S) NAME
BUSINESS ADDRESS
___________________________________________________ _____________________________________________________________________________
___________________________________________________ _____________________________________________________________________________
7.
ESTATE: Complete the following and attach a copy of the court or estate document(s):
Name of the court appointed administrator or personal representative: _____________________________________________________________________
List the type and date of issuance of the court or Estate document:
(Type of Document)
(Date issued)
§
8.
TRUST: (A) Complete the following pursuant to A.R.S.
33-404, for each beneficiary of the Trust:
NAME
ADDRESS
AGE
MARITAL STATUS
_____________________________________________ ____________________________________________________ ________ _____________________
_____________________________________________ ____________________________________________________ ________ _____________________
or (B) Identify the Trust document by title, document number, and county where document is recorded: ________________________________________
9.
I HEREBY CERTIFY, UNDER PENALTY OF PERJURY, THAT THE INFORMATION AND STATEMENTS CONTAINED HEREIN, TOGETHER
WITH ALL EXHIBITS AND ATTACHMENTS ARE TRUE, CORRECT AND COMPLETE AND THAT I/WE HAVE AUTHORITY TO SIGN THIS
SIGNATURE(S)
DOCUMENT.
(Name of Corporation, Partnership, etc.)
Signature of Assignor (Individual, Trustee, Personal Representative, etc
Signature
Title
Signature of Assignor (Individual, Trustee, Personal Representative, etc)
(Signatures must be notarized on page 4)
6100-05/94 (Rev. 08/2016dw) Assign
3
ASSIGNOR(S) A.K.A. SELLER(S)
NOTARY ACKNOWLEDGMENT
STATE OF ARIZONA
)
) ss.
County of _________________ )
On this
day of
, 20____ before me, a Notary Public within and for said
County, personally appeared
and known to me to be the person(s) described in and who executed the same as
free act and deed.
(his/her/their)
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
My Commission Expires:
Notary Public
STATE OF ARIZONA
)
) ss.
County of _________________ )
On this
day of
, 20____ before me, a Notary Public within and for said
County, personally appeared
and known to me to be the person(s) described in and who executed the same as
free act and deed.
(his/her/their)
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
My Commission Expires:
Notary Public
6100-05/94 (Rev. 08/2016dw) Assign
4
TO BE COMPLETED BY ASSIGNEE(S) A.K.A. BUYER(S)
CERTIFICATION: Pursuant to A.R.S. Title 37 and the Rules of the Arizona State Land Department, A.A.C. Title 12, Chapter 5, you must complete the following
information pertinent to you and sign the certification. NOTE: Applicant must complete item #1.
1.
Is this application made in the name of: (Applicant must check one)
____Individual(s)
____Husband & Wife
____Corporation
____Ltd. Liability Co.
____Partnership
____Ltd. Partnership
____Estate
____Trust
____Joint Venture
____Municipality
____Political Subdivision
____Other (specify) ___________________________________
2.
INDIVIDUAL(s) OR HUSBAND & WIFE: Complete the following for each applicant:
NAME
AGE
MARITAL STATUS
___________________________________________________________________________ ____________
___________________________________
___________________________________________________________________________ ____________
___________________________________
3.
CORPORATION: Complete the following:
(A) Do you have authority from the Arizona Corporation Commission to transact business in the State of Arizona?
Yes____ No____
(B) Is the corporation presently in good standing with the Arizona Corporation Commission?
Yes____ No____
(C) In what state are you incorporated? _____________________________________________________
(D) Is the legal corporate name and Arizona business address the same as stated in this application?
Yes____ No____
If no, state the Legal Corporate Name: __________________________________________________________________________________________
Address: ___________________________________________________________________________________________________________________
(Street or Box Number)
(City)
(State)
(Zip)
4.
LIMITED LIABILITY COMPANY: Complete the following:
(A) If an out-of-state limited liability company: Have you filed for a Certificate of Registration with the Arizona Corporation Commission?
Yes____ No____
(B) If an Arizona limited liability company: Have you filed Articles of Organization with the Arizona Corporation Commission?
Yes____ No____
(C) Are you authorized by the Arizona Corporation Commission to transact business in Arizona? Yes____ No____
5.
PARTNERSHIP OR JOINT VENTURE: Complete the following for each authorized partner or principal:
NAME
ADDRESS
AGE
MARITAL STATUS
_____________________________________________ _____________________________________________________ _______ ___________________
_____________________________________________ _____________________________________________________ _______ ___________________
6.
LIMITED PARTNERSHIP: Is this limited partnership on file with the Arizona Secretary of State? Yes____ No____
Complete the following for the authorized general partner(s) only:
GENERAL PARTNER(S) NAME
BUSINESS ADDRESS
___________________________________________________ __________________________________________________________________________
___________________________________________________ __________________________________________________________________________
7.
ESTATE: Complete the following and attach a copy of the court or estate document(s):
Name of the court appointed administrator or personal representative: ___________________________________________________________________
List the type and date of issuance of the court or Estate document: _______________________________________________________________________
(Type of Document)
(Date issued)
§
8.
TRUST: (A) Complete the following pursuant to A.R.S.
33-404, for each beneficiary of the Trust:
NAME
ADDRESS
AGE
MARITAL STATUS
_____________________________________________ ____________________________________________________ ________ _____________________
_____________________________________________ ____________________________________________________ ________ _____________________
or (B) Identify the Trust document by title, document number, and county where document is recorded: ________________________________________
9.
I HEREBY CERTIFY, UNDER PENALTY OF PERJURY, THAT THE INFORMATION AND STATEMENTS CONTAINED HEREIN, TOGETHER
WITH ALL EXHIBITS AND ATTACHMENTS ARE TRUE, CORRECT AND COMPLETE AND THAT I/WE HAVE AUTHORITY TO SIGN THIS
SIGNATURE(S)
DOCUMENT.
(Name of Corporation, Partnership, etc.)
Signature of Assignee (Individual, Trustee, Personal Representative, etc)
Signature
Title
Signature of Assignee (Individual, Trustee, Personal Representative, etc)
(Signatures must be notarized on page 6)
6100-05/94 (Rev. 08/2016dw) Assign
5
ASSIGNEE(S) A.K.A. BUYER(S)
NOTARY ACKNOWLEDGMENT
STATE OF ARIZONA
)
) ss.
County of _________________ )
On this
day of
, 20____ before me, a Notary Public within and for said
County, personally appeared ________________________________________________________________________
_________________________________________________________________________________________________
and known to me to be the person(s) described in and who executed the same as
free act and deed.
(his/her/their)
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
My Commission Expires:
Notary Public
STATE OF ARIZONA
)
) ss.
County of _________________ )
On this
day of
, 20____ before me, a Notary Public within and for said
County, personally appeared ________________________________________________________________________
_________________________________________________________________________________________________
and known to me to be the person(s) described in and who executed the same as
free act and deed.
(his/her/their)
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
My Commission Expires:
_____________________________________________
Notary Public
6100-05/94 (Rev. 08/2016dw) Assign
6