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COSSABOOM, ELLIOT AND CAROL
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Last modified
4/23/2021 3:24:50 PM
Creation date
12/8/2020 12:21:21 PM
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Template:
Contracts
Company Name
COSSABOOM, ELLIOT AND CAROL
Contract #
A-2020-223
Agency
Planning & Building
Council Approval Date
11/17/2020
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 <br />s^.snaic�tC.�..tY��=o.�rrn�:re�:ccrb�„c�.ctssrsz�ca:��.e� - <br />Fdocuitment <br />ary public or other officer completing this certificate verifies only the identity of the individual who signed the <br />to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. <br />State of Califor ' <br />County of _Q /��,, <br />On g before me, I� C��� t7 I f( {(� r v Uilf�n02i t <br />Gate ©� Gal Name and Title of the Officer <br />personally appeared � i lL <br />Name(s) of Signer(s) <br />who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are <br />subscribed to the within instrument and acknowledged to me that he/she/they executed the same in <br />his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), <br />or the entity upon behalf of which the person(s) acted, executed the instrument. <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 />RICARDO HERMAN MARtINE1 WITNESS my d and o ' ai seal. <br />z �,� Notary Public •California � <br />M Comm.rEn9iiesMaty Signature <br />21, 2o2a Signature of Notary Public <br />Place Notary Seal Above <br />OPTIONAL <br />Though this section is optional, completing this information can deter alteration of the document or <br />fraudulent reattachment of this form to an unintended document. <br />Description of Attached Document <br />Title or Type of Document: <br />Number of Pages: <br />Document Date: <br />Signer(s) Other Than Named Above: <br />Capacity(ies) Claimed by Signer(s) <br />Signer's Name: <br />❑ Corporate Officer — Title(s): <br />❑ Partner — ❑ Limited 0 General <br />© Individual !- Attorney in Fact <br />❑ Trustee t7 Guardian or Conservator <br />❑ Other: <br />Signer Is Representing: <br />Signer's Name: <br />W:1 Corporate Officer — Title(s): <br />D Partner — ❑ Limited f_l General <br />C] Individual I Attorney in Fact <br />`I Trustee ! .I Guardian or Conservator <br />11 Other: <br />Signer Is Representing: <br />02014 National Notary Association - www.NationalNotary.org - 1-800-US NOTARY (1-800-876-6827) item H5907 <br />
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