THE STATE OF SOUTH CAROLINA,)
I, _________________________________________________ do hereby certify unto all whom it may concern that Mrs. _________________________ the wife of the within-named _______________________________ did this day appear before me, and upon being privately and separately examined by me, did declare that she does freely, voluntarily, and without any compulsion, dread or fear of any person or persons whomsoever, renounce, release and forever relinquish unto the within-named _____________________________ Heirs and Assigns, all her interest and estate, and also all her right and claim of dower, of, in or to all and singular the premises within mentioned and released.
Given under my Hand and Seal, this _____________
day of _______________________, Anno Domini, 20_____
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