State of Arkansas
County of ___________
On this day before the undersigned, a _________________________ duly qualified and acting in and for the county and state aforesaid, personally appeared _____________, [to me well know] [satisfactorily proven] to be the person (s) whose name (s) appear (s) as _____________ in the foregoing instrument, and stated that (s) he has executed the same for the consideration, uses and purposes therein stated.
[And on the same day also voluntarily and personally appeared before me ______________, wife of _____________, [to me well known] [satisfactorily proven] to be the person whose name appears as _________________ in the foregoing instrument, and in the absence of her husband stated that she has executed the foregoing instrument of her own free will and had signed and sealed the relinquishment of dower and homestead therein expressed, for the purposes and consideration therein stated.]
In witness whereof, I hereunto set my hand [and seal] on this ___________ day of ______________.
My commission expires:
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