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JURAT <br />A notary public or other officer completing this certificate verifies only the identity of <br />the individual who signed the document to which this certificate is attached, and not <br />the truthfulness, accuracy, or validity of that document. <br />State of California <br />County ofSCkn P)erYtard',IUi <br />Subscribed and sworn to (or affirmed) before me on this 1*day of e bj, <br />20 by rm n t� t r l C b r -i m <br />proved to me on the basis of satisfactory evidence to be the person/) who appeared <br />before me. <br />CAI AM I m <br />ignature (Seal) <br />OPTIONAL INFORMATION <br />DE CRIPTION OF THE ATTACHED DOCUMENT <br />(Title or descri on of attached d cument) <br />(Tite or description of attached document continued) <br />Number of Page—L Document Date C lCl <br />Additional information <br />RRIST11NNMBRERAI <br />p CO214796a NotaCalilgniaz CoCountyCom.1 2t>Zl <br />INSTRUCTIONS <br />The wording of all Jurors completed in California after January 1, 2015 must be in the form <br />as set forth within this Juraf. There are no exceptions. If a Jurat to be completed does not <br />follow this form, the notary must correct the verbiage by using ajuraf stamp containing the <br />correct wording or attaching a separate jurat form such as this one with does contain the <br />proper wording. In addition, the notary must require an oath or affirmation from the <br />document signer regarding the truthfulness of the contents of the document. The <br />document must be signed AFTER the oath or affirmation. If the document was previously <br />signed, it must be re -signed in front of the notary public during thejurat process. <br />• State and county information must be the state and county where the <br />document signer(s) personally appeared before the notary public. <br />• Date of notarization must be the date the signers) personally <br />appeared which must also be the same date the jurat process is <br />completed. <br />• Print the name(s) of the document signer(s) who personally appear at <br />the time of notarization. <br />• Signature of the notary public must match the signature on file with the <br />office of the county clerk. <br />• The notary seal impression must be clear and photographically <br />reproducible. Impression must not cover text or lines. If seal impression <br />smudges, re -seal if a sufficient area permits, otherwise complete a <br />different jurat form. <br />Additional information Is not required but could help <br />to ensure this jurat is not misused or attached to a <br />different document. <br />Indicate title or type of attached document, number of <br />pages and date. <br />• Securely attach this document to the signed document with a staple. <br />2015 Version �+rww.Nol6�:yClasaes.:;nm 800273-g8GS <br />