CERTIFICATION
The undersigned deposes and says that (s)he has duly executed the attached application dated
_______________, 20___, for and on behalf of_______________________________ that (s)he is the
(Name of Applicant)
__________________________of such company and that (s)he is authorized to execute and file such
(Title of Officer)
instrument. Deponent further says that (s)he is familiar with such instrument and the contents thereof,
and that the facts therein set forth are true to the best of his/her knowledge, information and belief.
(Signature)___________________________
(Type or print name beneath)___________________________
NDOI-411 / July 2016