The verification described in section 21-05-01 may be in substantially the following form:

Certificate

I do hereby certify that the within bill, claim, account, or demand is just and true; that the money therein charged actually was paid for the purpose therein stated; that the services therein charged actually were rendered and of the value therein charged, that no part of such bill, claim, account, or demand has been paid; and that the goods therein charged actually were delivered and were of the value charged.

Sign Here _______

If signed for a firm or company show authority on this line.