STATE OF MISSOURI)
COUNTY OF _____________)
On this _______ day of ___________________ in the year 20_____, before me, a Notary Public, in and for said state, personally, appeared _____________________
_____________________________, attorney-in-fact for _______________________
______________________ known to me to be the person who executed the within instrument in behalf of said principal (or surety), and acknowledged to me that ______ executed the same for the purposes therein stated.
________________________________ Notary Public
My Commission Expires: ___________
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