fill in the blanks!

Debbie, this site describes all of the applicable laws and forms for notaries in the state of Texas: http://www.sos.state.tx.us/statdoc/edinfo.shtml

The "Form for Ordinary Certificate of Acknowledgment," the standard form for most ordinary purposes, is reproduced below. The blanks here correspond to:

1) Texas county under which the notary is registered,
2) The person requesting the notary's services
3) A witness,
4) An ordinal number (first, second, third, etc.) denoting the day of the month, and
5) The year as a four-digit number (2004, 2005, etc.).

The notary's official seal appears below the notary's signature as indicated.
________________________________________

State of Texas
County of _______________

Before me, (insert the name and character of the officer), on this day personally appeared ____________________, known to me (or proved to me on the oath of ______________ or through (description of identity card or other document)) to be the person whose name is subscribed to the foregoing instrument and acknowledged to me that he executed the same for the purposes and consideration therein expressed.

Given under my hand and seal of office this __________ day of __________, (year).

______________________
Notary Public's Signature
(Personalized Seal)

I have a release of all claims and above the notary & witness signatures, there is this statement:
WITNESS___________ hand and seal this ______ day of _________, 2017; what is put in after WITNESS?