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BUSSARD, CAMRON AND PHYLLIS
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BUSSARD, CAMRON AND PHYLLIS
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Last modified
4/23/2021 3:05:52 PM
Creation date
12/8/2020 12:12:19 PM
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Contracts
Company Name
BUSSARD, CAMRON AND PHYLLIS
Contract #
A-2020-220
Agency
Planning & Building
Council Approval Date
11/17/2020
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CALIFORNIA ALL-PURPOSE ACKNOWLEDOMENT CIVIL <br />.. 1189 <br />.ait.a�t.` <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 truthfulness, accuracy, or validity of that document. <br />State of California <br />County of QVQM �j 2 <br />On_Noltenh- 1L( , LOU beforeme, watsAn /Q 4k . Ajov-rj PC, b/%C <br />Date Here Insert Name anq Title of the Officer <br />personally appeared c6imVov� &U55arpt Gtr}( p11Y111'f 19ft55ewd <br />Name() of SigneC�js <br />who proved to me on the basis of satisfactory evidence to be the persMinstrument <br />whose nam� i0, ar <br />su�lscri to the within instru ent and acknowledged me that h�/s15eexecuted the same n <br />tlig/h4r hei authorized capaci ies and that by hig/t��r ei signatures on the persoros <br />r the e y upon behalf of whi a persole acted, executed the instrument. <br />1{-,4 WALSAN MTN <br />Commission/2321222 <br />Notary Fubik - Ca01omla <br />Cranp County <br />My Comm. Esp. FEB.11, 2024 <br />Place Notary Seal Above <br />I certify under PENALTY OF PERJURY under the laws <br />of the State of California that the foregoing paragraph <br />is true and correct. <br />WITNESS my hand and official seal. <br />Signature 7✓•11, <br />Signature of Notary Public <br />OPTIONAL <br />Though this section is optional, completing this information can deter alteration of the document or <br />fraudulent reattachment of this forrr'I to an unintended document. <br />Description of Attached Document <br />Title or Type of Document: <br />Number of Pages: <br />Document Date: <br />Signers) Other Than Named Above: <br />Capacity(ies) Claimed by Signer(s) <br />Signer's Name: <br />❑ Corporate Officer — Title(s): <br />❑ Partner — ❑ Limited ❑ General <br />❑ Individual I Attorney in Fact <br />❑ Trustee n Guardian or Conservator <br />❑ Other: <br />Signer Is Representing: <br />Signer's Name: <br />Corporate Officer — Title(s): <br />❑ Partner — f1 Limited CI General <br />❑ Individual I I Attorney in Fact <br />❑ Trustee t I Guardian or Conservator <br />❑ Other: <br />Signer Is Representing: <br />o t va :tr • ar 16 <br />
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