COMMONWEALTH OF MASSACHUSETTS
______________, SS.
On this ________ day of ________, 200__, before me, the undersigned notary public, personally appeared __________________, proved to me through satisfactory evidence of identification, which were _________________________________, to be the person whose name is signed on the preceding document, and acknowledged to me that she signed it voluntarily for its stated purpose.
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Notary Public:
My Commission Expires: ______________
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