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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 />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 />Countyof A <br />On before me, I�t(6t10D (VYKIr i ��?i Ala <br />ate � Z and Title of the <br />personally appeared rot %/R& (/� So <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 />�.:;:� . 31CrUa",) F:fii!:1 N MAR71NE2 <br />Ct�Mf:S, :;2325L�91 z <br />rc $•�. J�),I Nolary pubic - Caliiurnia z <br />z r% Orz�ge Crn,�ty <br />MCcmm. xp"i,ti Ata21, 2024 <br />1 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 14 <br />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 ❑ General <br />❑ Individual I -A Attorney in Fact <br />❑ Trustee 0 Guardian or Conservator <br />❑ Other: <br />Signer is Representing: <br />Signer's Name: <br />I_1 Corporate Officer — Title(s): <br />❑ Partner — ❑ Limited _I General <br />El Individual Li Attorney in Fact <br />❑ Trustee ❑ Guardian or Conservator <br />Other: <br />Signer Is Representing: <br />-c�:r:?"�z~��r;�c^�v��.�.•co�=r>ec^��r.._ _ _ _ �cna^x=e�t�.�c^u;�c�^et� <br />02014-National Notary Association • www.NationaiNotary.org - 1-800-US NOTARY (1-800-876-6827) Item #5907 <br />
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