ID Acknowledgment-Individual 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 __ _________________________________________________________________ subscribed to the within instrument, and acknowledged to me that __ he __ executed the same.

Notary Public: ________________________________________________

Residing at: ___________________________________________________

My Commission Expires: ________________________________________

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