VT Acknowledgment-Individual 1

STATE OF VERMONT

COUNTY OF ___________________, SS.

At __________, in said County, on this _________ day of __________, 20______, _____________________ personally appeared and he/she/they acknowledged this instrument, by him/her/them sealed and subscribed, to be his/her/their free act and deed,

Before me, _________________________________

Notary Public

My commission expires: 2/10/03

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