STATE OF KENTUCKY )
COUNTY OF _____________________ )
I hereby certify that the foregoing deed and consideration statement was acknowledged and sworn to before me this ___________ day of _________ by _________________, a _________________________ of _________________________, a Kentucky Corporation, party of the first part, and __________________________ , party of the second part.
_____________ County Kentucky or State at Large, Kentucky
My Commission Expires: ______________
This instrument was prepared by:
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