ID Acknowledgment-Fiduciary/Official 1

STATE OF ___________________, County of ______________________, ss

On this ________ day of ________________, in the year of _____, before me _______________________________________________, a notary public, personally appeared ________________________________________________________, known or identified to me to be the person whose name is subscribed to the within instrument as (trustee, sheriff, etc.) ______________________________________________ and acknowledged to me that ______ executed the same as such ____________________ (trustee, sheriff, etc.).

Notary Public: _______________________________________

Residing at: _________________________________________

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