La Scuola Authorization Of Temporary Guardianship Page 4
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4Signed at ______________________on this ______day of _________________20____
SIGNATURE _____________________________(Parent / Guardian)
SIGNATURE _____________________________(Parent / Guardian)
WITNESS 1:
_____________________________
WITNESS 2:
_____________________________
Certificate of Acknowledgment of Notary Public
State of _______________________________
)
County of _____________________________
)
On _____________________, before me, ______________________________, a notary
public in and for said state, personally appeared ___________________
________________________, known to me (or proved to me on the basis of satisfactory
evidence) to be the person whose name is subscribed to the within instrument, and
acknowledged to me that he or she executed the same in his or her authorized capacity and
that by his or her signature on the instrument, the person, or the entity upon behalf of which the
person acted, executed the instrument.
WITNESS my hand and official seal.
_____________________________________
Notary Public for the State of California
My commission expires __________________
[NOTARY SEAL]
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