COMMONWEALTH OF MASSACHUSETTS
______________, SS.
On this ________ day of ________, 20__, before me, the undersigned notary public, __________________ (name of document signer) personally appeared, proved to me through satisfactory evidence of identification, which was/were _____________________, to be the person whose name is signed on the preceding or attached document, and acknowledged to me that they signed it voluntarily for its stated purpose.
[affix or imprint official seal]
____________________________________
, Notary Public
My Commission Expires:
No guidelines are available for this form at this time.