HOSPITAL, HOSPICE and NURSING HOME SERVICE FORM

Hospital Notary | Hospice and

Nursing Home | Zekes Mobile |

Bakersfield, Ca

Your Friendly Neighborhood Mobile Agent.....
Your Name

First Name Last Name
Your Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Your Email
example@example.com
Your Phone Number

Area Code Phone Number
Patient who is the Principal of the Power of Attorney

First Name Last Name
Relationship to you:
Type of Document(s) needing to be Notarized:

Durable Power of AttorneyHealth Care DirectiveTransfer of DeedPower of Attorney for Bank: certain Banks have their own POALast Will and TestamentMarriage Packet/Wedding Officiant at Hospital
Additional Details, Other Services or Questions:
Signers Must Have Identification Cards: For a smooth transaction, please be sure that your loved one, the patient , has their current identification card
(preferred if unexpired) , i.e. State Driver's License, State ID Card or Passport. Notary public must be able to properly identify the signer of the documents before the documents can be notarized.
Name of Hospital or Nursing Facility
Room Number
Address of Facility

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
As the Notary Public completing this certificate above. I verify only the identity of the individual(s) who signed the document to which this certificate is attached to and not the truthfulness, accuracy, or validity of that document. You will be charged for each signature(s) that sign the document that requires the above Certificate: either if its just one signer, two signers or more.
Prefer Method(s) of Contact

Call meTextEmail
All information is held strictly private. I do not lend, sell, trade, or give away your private information to any vendor, person, or organization of any kind. I respect your privacy!
PLEASE CONTACT ME AT (661) 496-6679

LET ME KNOW THAT YOU JUST SUBMITTED A REQUEST FOR HOSPITAL OR NURSING HOME.
Zekes Mobile Multi-Services

zekesmobilemultiservices@yahoo.com

(661) 496-6679
(There will be a Credit Card Processing Fee)

NO REFUNDS FOR NOTARY SERVICES RENDERED AND COMPLETED WITHIN A TIMELY MANNER AND OR FOR ANY DEPOSITS PAID TO HOLD A DATE AND FOR TIME FOR ALL PROFESSIONAL SERVICES PROVIDED IN GOOD FAITH.

IF IT IS FOUND THAT I MADE AN HONEST MISTAKE, I WILL REDO YOUR NOTARY FOR FREE.

A STATE ISSUED PHOTO I.D. AND THUMB PRINT IS REQUIRED FROM ALL SIGNERS.
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