Corporate Acknowledgement : Please fill out the following form. Please print your completed form if you would to have a copy for your records.



STATE OF :

COUNTY OF :


On the day of (DATE) before me personally appeared (name of the person who signed the attached document) who being by me duly sworn, did depose and say that he is the (Business title) of (Name of the corporation), the corporation described in andwhich executed the annexed document; that he knows the seal of said corporation; that the seal affixed is such corporate seal; that it was so affixed by order of the Board of Directors of saidcorporation, and that he signed his name thereto by like order.


On _________________________ before me ________________________ personally appeared ___________________________ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.


WITNESS my hand and official seal.


Signature :


Affiant : Known / Unknown


ID Produced :


Seal :





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