FIN462 | 0415
Executed this the ______ day of ____________________, 20______ by the undersigned officer of said company
and trustee for said company duly and legally authorized thereunto.
___________________________________
___________________________________
(Name of Company)
(Name of Bank)
Printed Name: _______________________
Printed Name: ________________________
Signature: __________________________
Signature: __________________________
Title: _____________________________
Title: _______________________________
Date: _____________________________
Date: _______________________________
Address: __________________________
Address: ____________________________
NOTARY’S ACKNOWLEDGMENT
(FOR THE COMPANY)
STATE OF _________________________
COUNTY OF _______________________
Before me, the undersigned authority, on this day personally appeared ____________________, the
_________________________ of the ____________________________________________ known
(Title)
(Name of Company)
to me to be the person whose name is subscribed to the above and foregoing instrument which is to be held in
accordance with the terms of the agreement.
Given under my hand and seal of office this the ______ day of __________________, 20______.
__________________________
______
(Notary Public)
My Commission Expires ____________________
County of_______________, State of _________
NOTARY’S ACKNOWLEDGMENT
(FOR THE BANK)
STATE OF _________________________
COUNTY OF _______________________
Before me, the undersigned authority, on this day personally appeared ____________________, the
_________________________ of the ____________________________________________ known
(Title)
(Name of Company)
to me to be the person whose name is subscribed to the above and foregoing instrument which is to be held in
accordance with the terms of the agreement.
Given under my hand and seal of office this the ______ day of __________________, 20______.
_____________
___________________
(Notary Public)
My Commission Expires ____________________
County of_______________, State of _________
Texas Department of Insurance |
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