STATE OF _________________________
COUNTY OF _______________________
Personally appeared, before me, the undersigned authority in and for the said county and state, on this ________ day of ________________ 20_____, within my jurisdiction, the within named ____________________________________________, who acknowledged that (he)(she) is _____________________ of _____________________________, a corporation, and that for and on behalf of the said corporation, and as its act and deed (he)(she) executed the above and foregoing instrument, after first having been duly authorized by said corporation so to do.
My Commission expires:
(Affix official seal, if applicable)
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