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 of 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.