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23B - BRISTOL ST REHAB
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12/17/2019
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23B - BRISTOL ST REHAB
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Last modified
12/12/2019 5:43:58 PM
Creation date
12/12/2019 5:33:35 PM
Metadata
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Template:
City Clerk
Doc Type
Agenda Packet
Agency
Public Works
Item #
23B
Date
12/17/2019
Destruction Year
2024
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT CIVIL CODE § 1189 <br />A notary public or other officer completing this certificate verifies only the identity of the individual who signed the <br />document to which this certificate is attached. and not the tmthfuIness. accuracy. nr validity of that document. <br />State of California <br />County of Riverside <br />On October 16, 2019 before me, Courtney Chapas, Notary Public <br />Date Here Insert name and Tige of the oRcer <br />personally appeared Edward J. Carlson <br />Name(s) of Signer(s) <br />f <br />V <br />who proved to me on the basis of satisfactory evidence to be the <br />person(s) whose name(s) is/are subscribed to the within instrument <br />and acknowledged to me that he/she/they, executed the same in <br />� his/hef4l4e# authorized capacity(les), and that by his/her/the <br />-_ COURTNEY CHAPAS signature(s) on the instrument the person(s), or the entity upon behalf <br />,?� v Notary Public • California L of which the person(s) acted, executed the instrument. <br />i �.F.® - Riverside County z <br />z 0' Commission x 2172984 = 1 certify under PENALTY OF PERJURY under the laws of the State of <br />My Comm. Expires Nov 20, 2020 California that the forgoing paragraph is true and correct. <br />WITNESS my hand and off 'al seal.1/�(�n <br />Signature V <br />Place Notary Seal Above Sign V <br />of Notarflublic <br />OPTIONAL <br />Though the information below is not required by law, it may prove valuable to person relying on the document <br />and could prevent fraudulent removal and reattachment of this form to another document. <br />Description of Attached Document <br />Title or Type of Document <br />Document Date: October 14 2019 Number of Pages: <br />Signer(a) Other Than Named Above: <br />Capacity(ies) Claimed by Signer(s) <br />Signer's Name: Edward J. Carlson <br />❑ Individual <br />X Corporate Officer —Title(s): Vice President <br />❑ Partner 11 ❑ Limited o General <br />❑ Attorney in Fad <br />❑ Trustee <br />❑ Other: <br />net is <br />Sign Name: <br />❑ Indivi I <br />❑Corporate Icer—Title(s):_ <br />❑ Partner 1 ❑ Lim d ❑ General <br />❑ Attorney in Fad <br />Top of Numb here ❑ Trustee <br />❑ Other: <br />is <br />Top of thumb here <br />23B-17 <br />
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