TX Notary Public: Execution for the Disabled 1

_______________________________ (Signed Name)

by (name of notary public)

Signature affixed by notary in the presence of (name of witness), a disinterested witness, under Section 406.0165, Government Code.

_____________________________

(name) Disinterested Witness

State of Texas

County of __________

This instrument was acknowledged before me on _________________________ (date) by __________________________ (name of "disabled person").

______________________________

Notary Public in and for Texas

My commission expires: _____________________

State of Texas

County of __________

Before me the undersigned authority on this day duly appeared (name of witness), who being duly sworn, on his/her oath swore that (1) (name of disabled person) has a physical disability, (2) in (name of witness's) presence, (name of disabled person) directed (notary public) to sign (name of disabled person's) name on the above document, presented for notarization, (3) (name of witness) has no legal or equitable interest in any property subject to or affected by the document, and (4) the notary requested identification of (name of witness) in the same manner as required from an acknowledging person under Section 121.005, Civil Practice and Remedies Code.

____________________________

Notary Public in and for Texas

My Commission expires___________________