North Dakota Indian Communitization Agreement Page 4
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4IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day
and year first above written and have set opposite their respective names the date of execution.
:
*NAME OF
.......
DATE
SIGNATURE
TITLE
* N ote: CA may require multiple signature pages. A separate signature page is required for each choice that is
applicable.
ACKNOWLEDGEMENT
STATE OF
)
) ss.
COUNTY OF
)
On this
day of
, 20
, before me, a Notary Public for the State of
, personally appeared
, known to
me to be the
of
, the corporation
that executed the foregoing instrument and acknowledged to me such corporation executed the same.
(SEAL)
Notary Public
Signature
Printed Name
My Commission Expires:
ND INDIAN CA
revised 10/6/2014
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