Consent To Service Of Process - Tennessee Department Of Commerce & Insurance Page 2
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1
2Debt Management Services Program
500 James Robertson Parkway
Nashville, TN 37243
Tel: 615-741-1831 • Fax: 615-253-1692
CORPORATE ACKNOWLEDGEMENT
State or Province of ________________________
County of _________________________________
On
this
__________
day
of
_______________,
______,
before
me
_______________________________
the
undersigned
officer,
personally
appeared_______________________________________________ _____known personally to
me to be the ___________________________ (title) of the above named corporation and
acknowledged that he/she, 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
My Commission Expires: ______________
INDIVIDUAL OR PARTNERSHIP ACKNOWLEDGMENT
State or Province of ________________________
County of _________________________________
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
My Commission Expires: ______________
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