STATE OF MISSOURI)
)ss.
COUNTY OF __________________)
On this ________ day of ____________________ in the year 20___, before me, a Notary Public in and for said state, personally appeared _______________________________, known to me to be the same person(s) described in and who executed the within instrument, and acknowledged to me that ______ executed the same for the purpose therein stated.
________________________________
Notary Public
My Commission Expires: ____________
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