STATE OF WASHINGTON)
) SS.
County of @)
I certify that I know or have satisfactory evidence that @ is/are the person(s) who appeared before me, and said person(s) acknowledged that he/she/they signed this instrument and acknowledged it to be his/her/their free and voluntary act for the uses and purposes mentioned in this instrument.
DATED: @
____________________________________________________
Name (typed or printed): @ __________________________
NOTARY PUBLIC in and for the State of @ _________
Residing at @ ______________________________________
My appointment expires: @ _________________________
No guidelines are available for this form at this time.