NOTARY ACKNOWLDEGEMENT
STATE OF __________________________
COUNTY OF __________________________
On this _____ day of _________, 20___, before me, _______________________, Notary Public, personally
appeared ______________________________________________, personally known to me (or proved to me
on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and
acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the
instrument, he executed the instrument.
WITNESS my hand and official seal.
Signature: _________________________________
My commission expires on: ____________________
(Seal)