STATE OF ______________
County of _______________
On this _________day of ________, 20 _______, before me a Notary Public personally appeared A B, to me known to be the person who executed the foregoing instrument in behalf of C D, and acknowledged that the executed the same as the free act and deed of C D.
In Testimony Whereof, I have hereunto set my hand and affixed my official seal the day and year last above written.
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Notary Public: ______________________
My Commission Expires: _________________
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time.
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