Notary
A cknowledgment
State
o f:
_ ______________________
County
o f:
_ _____________________
On
_ ___/____/______,
b efore
m e,
_ ________________________________________________,
(notary)
Personally
a ppeared,
Landlord
T enant
_________________________________
_ ________________________________
_ _________________________
_ _________________________
Name:
N ame:
_ _________________________
_ _________________________
Date:
D ate:
☐
P ersonally
k nown
t o
m e
OR
☐
Proved
t o
m e
o n
t he
b asis
o f
s atisfactory
e vidence
t o
b e
t he
p erson(s)
w hose
name(s)
i s/are
s ubscribed
t o
t he
w ithin
i nstrument
a nd
h as
h ereby
a cknowledged
to
m e
t hat
h e/she/they
h ave
e xecuted
t he
s ame
i n
h is/her/their
a uthorized
capacity(ies),
a nd
t hat
b y
h is/her/their
s ignature(s)
o n
t he
i nstrument
t he
person(s)
o r
t he
e ntity
u pon
b ehalf
o f
w hich
t he
p erson(s)
a cted,
e xecuted
t he
instrument.
Witness
m y
h and
a nd
o fficial
s eal
_______________________________________________
Notary
S ignature
_______________________________________________
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N ame