2020–2021 Verification of Identity and
Statement of Educational Purpose (Notarized)
Notary’s Certificate of Acknowledgement
State of___________________________________________________________ City/County of ____________________________________________
On, ______________________________________________ before me, _______________________________________________________________
(Date) (Notary’s Name)
Personally appeared, _______________________________________________________________ and provided to me
(Printed name of signer)
on basis of satisfactory evidence of identification ___________________________________________________________________________
(Type of government-issued ID provided)
to be the above-named person who signed the foregoing instrument.
WITNESS my hand and official seal
(seal)
Notary Signature __________________________________________________
My commission expires on ___________________________________________________________________________
(Date)
CPS Correction Date __________________________________________________________________________________
Mitchell Community College Financial Aid Office, 500 West Broad Street, Statesville, NC 28677
Phone (704) 978-5435 Fax (704) 978-1302
MCC-458 Equal Opportunity College Rev. 05/20
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