STATE OF NORTH DAKOTA)
) SS.
COUNTY OF _______________________)
On this ____ day of _________________, 20_____, before me, personally appeared ______________________________________________________, known to me to be the person__ who __ described in, and who executed the within and foregoing instrument, and severally acknowledged that _____ executed the same.
____________________________________________
Notary Public
______________________________ County, N.D.
My commission expires:
___________________________, 20_____
No guidelines are available for this form at this time.