State of _______________ )
County of ____________ )
This instrument was acknowledged before me on (date) by (name(s) of person(s)) as (type of authority, e.g., officer, trustee, etc.) of (name of party on behalf of whom instrument was executed).
________________________ (Signature of notarial officer)
(Seal, if any)
_____________________________________
Title (and Rank)
My commission expires: _________________
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