STATE
OF STATE
NAME )
)ss.
COUNTY
OF COUNTY NAME )
On
this DAY day of MONTH , in the year of YEAR , before me, NAME
OF NOTARY , personally appeared NAMES
OF ENTITIES
, known or identified to me (or proved to me on the oath of ), to be the president,
or vice president, or secretary or assistant secretary, of
the corporation that executed the instrument or the person who executed the instrument
on behalf of said corporation, and acknowledged to me that HE,
SHE OR THEY of
such corporation executed the same.
________________________________
Notary
Public of
Residing
at:
Commission
Expires: