TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE IN NEW YORK STATE
State of New York, County of
ss:
State of New York, County of
ss:
On the
day of
in the year
On the
day of
in the year
before me, the undersigned, personally appeared
before me, the undersigned, personally appeared
personally known to me or proved to me on the basis of
personally known to me or proved to me on the basis of
satisfactory evidence to be the individual(s) whose name(s) is
satisfactory evidence to be the individual(s) whose name(s) is
(are) subscribed to the within instrument and acknowledged to
(are) subscribed to the within instrument and acknowledged to
me that he/she/they executed the same in his/her/their
me that he/she/they executed the same in his/her/their
capacity(ies), and that by his/her/their signature(s) on the
capacity(ies), and that by his/her/their signature(s) on the
instrument, the individual(s), or the person upon behalf of which
instrument, the individual(s), or the person upon behalf of which
the individual(s) acted, executed the instrument.
the individual(s) acted, executed the instrument.
___________________________________________________
__________________________________________________
(signature and office of individual taking acknowledgment)
(signature and office of individual taking acknowledgment)
TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE OUTSIDE NEW YORK STATE
State (or District of Columbia, Territory, or Foreign Country) of
ss:
On the
day of
in the year
before me, the undersigned, personally appeared
personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are)
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and
that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted,
executed the instrument, and that such individual made such appearance before the undersigned in the
_________________________________________ in ____________________________________________________________.
(insert the City or other political subdivision)
(and insert the State or Country or other place the acknowledgment was taken)
_______________________________________________________
(signature and office of individual taking acknowledgment)
DISTRICT
SECTION
BLOCK
Q
D
UITCLAIM
EED
LOT
COUNTY OR TOWN
Title No. ________________________________
STREET ADDRESS
TO
Recorded at Request of
RETURN BY MAIL TO:
STANDARD FORM OF NEW YORK BOARD OF TITLE UNDERWRITERS