以下为美国国务院证书样本英文本及其中文翻译件，仅供参考，欢迎指正。

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United States Of America

DEPARTMENT OF STATE

To all to whom these presents shall come, Greetings:

I Certify That the document hereunto annexed is under the Seal of the State(s) of [name of state], and that such Seal(s) is/are entitled to full faith and credit.*

*For the contents of the annexed document, the Department assumes no responsibility. This certificate is not valid if it is removed or altered in any way whatsoever

In testimony whereof, I, [Full Name of Secretary of State], Secretary of State , have hereunto caused the seal of the Department of State to be affixed and my name subscribed by the Assistant Authentication Officer, of the said Department, at the city of Washington, in the District of Columbia, this [date[2]] day of [month[3]], xxxx[4].

__________________(Signature)__________________

By____________________(Signature)_____________

Assistant Authentication Officer,

                              Department of State

Issued pursuant to CHXIV, State of Sept. 15, 1789, 1 Stat. 68-69; 22 USC   2657; 22USC 2651a; 5 USC 301; 28 USC 1733 et. seq.; 8 USC 14430; RULE 44 Federal Rules of Civil Procedure.

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美利坚合众国

国务院

敬启者：

本人特此证明，本文所附文件盖有[州名]州公章，该等印章可予充分信任和信赖。*

*对所附文件之内容，国务院概不承担任何责任。

如以任何方式撕下或篡改，本证明即属无效。

本人，[国务卿姓名]，系美国国务卿，已责成国务院助理认证官于[xxxx]年[xx]月[xx]日在华盛顿哥伦比亚特区在本文件上加盖国务院印章并签上本人姓名，以资证明。