State of __________________
County of ________________
The foregoing instrument was acknowledged before me this (date) by (name of officer or agent, title of officer or agent) of (name of corporation acknowledging) a (state or place or [sic] incorporation) corporation, on behalf of the corporation.
(Signature of person taking acknowledgment)
(Title or Rank)
(Serial number, if any)
No guidelines are available for this form at this time.