State of Virginia,
City/County of ___________________, to-wit:
I, _______________________, a notary public of the City/County of ______________, State of Virginia, do hereby certify that ____________________, whose name is signed to the writing above bearing date on the _____ day of _______________, 20_____, has acknowledged the same before me in my State aforesaid.
Given under my hand this ____ day of _______________, 20_____.
[Seal]
________________________________________
Notary Public
My Commission expires:
No guidelines are available for this form at this time.