STATE OF _________________________
COUNTY OF _______________________
Personally appeared, before me, the undersigned authority in and for the said county and state, on this ________ day of ________________ 20_____, within my jurisdiction, the within named ____________________________________________, who acknowledged that (he)(she)(they) executed the above and foregoing instrument.
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(NOTARY PUBLIC)
My Commission expires:
____________________
(Affix official seal, if applicable)
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