CORPORATE ACKNOWLEDGMENT
State or Province of ________________________ )
County of _________________________________) ss.
On this __________ day of _______________, ______, before me _______________________________ the
undersigned officer, personally appeared ____________________________________________________ _____known
personally to me to be the ___________________________ of the above named corporation and acknowledged that he
TITLE
, as an officer being authorized so to do, executed the foregoing instrument for the purposes therein contained, by signing
the name of the corporation by himself as an officer.
IN WITNESS WHEREOF I have hereunto set my hand and official seal.
_______________________________________________________
NOTARY PUBLIC/COMMISSIONER OF OATHS
My commission expires: _______________________________
INDIVIDUAL OR PARTNERSHIP ACKNOWLEDGMENT
State or Province of ________________________ )
County of _________________________________) ss.
On this __________ day of _______________, ______, before me __________________________________, the
undersigned officer, personally appeared ___________________________________________________________ to me
personally known and known to me to be the same person(s) whose name(s) is (are) signed to the foregoing instrument,
and acknowledged the execution thereof for the uses and purposes therein set forth.
IN WITNESS WHEREOF I have hereunto set my hand and official seal.
_______________________________________________________
NOTARY PUBLIC/COMMISSIONER OF OATHS
My commission expires: ________________________________
SC-610-065 CONSENT TO SERVICE (R/3/92) Page 3 of 5