NOTARY PAGE
_____________________________________________________DATE_______
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Full Legal Name
Sign here in front of Notary
PROVINCE OF
____________________________ )
) ss.
TOWN/CITY OF
__________________________ _________________)
On the _______
day of _________________, _________, before me, the undersigned Notary
Public, personally appeared BEFORE ME, _____________________, to me known
to be the individual described in and who executed the within and foregoing
instrument and acknowledged to me under oath that he signed the same of
his free and voluntary act and deed, for uses and purposes therein mentioned.
IN WITNESS WHEREOF, I have
set my hand and seal the day and year as above written.
_________________________________________________________
Notary Public in and for the
Residing at __________________________________________
My Commission Expires: ____________________
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