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COMMUNITY DEVELOPMENT AGENCY/LATINO HEALTH ACCESS-2009
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COMMUNITY DEVELOPMENT AGENCY/LATINO HEALTH ACCESS-2009
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Last modified
1/3/2012 3:11:15 PM
Creation date
4/20/2010 11:14:47 AM
Metadata
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Template:
Contracts
Company Name
COMMUNITY DEVELOPMENT AGENCY/LATINO HEALTH ACCESS
Contract #
A-2007-296-001
Agency
Community Development
Council Approval Date
3/19/2007
Expiration Date
9/22/2010
Insurance Exp Date
5/20/2010
Destruction Year
2015
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT <br />STATE OF CALIFORNIA <br />County of } <br />021-(°C'- (? - 2©oq before me, <br />Date Here Insert Name and Title of the i er <br />n <br />personally appeared <br />who proved to me on the basis of satisfactory evidence to <br />be the person(e) whose name( is/afasubscribed to the <br />within instrument and acknowledged to me that#to/she/tAeyL <br />executed the same in We/her/gui4r-authorized capacity(ies), <br />and that by4s/her/thei?signature(s)-on the instrument the <br />person4), or the entity upon behalf of which the persoI <br />acted, executed the instrument. <br />w.. <br />131,11 fARTI .......?? <br />NOTARY PUBLIC • cau??? « <br />Place Notary Seal Above <br />certify under PENALTY OF PERJURY under the laws of <br />the State of California that the foregoing paragraph is true <br />and correct. <br />Witness my hand and official seal. <br />r- . <br />Signature <br />Signature of Notary Public <br />OPTIONAL <br />Though the information below is not required by law, it may prove valuable to persons 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: 171 Y S 1" lj)21 A ,,n o Lon n i-En ± ?.Cartc7 U+lcl s e <br />Document Date: r Number of Pages: -S <br />. <br />Signer(s) Other Than Named Above: <br />Capacity(ies) Claimed by Signer(s) <br />Signer's Name: <br />El Individual <br />El Corporate Officer-Title(s): <br />El Partner - El Limited El General <br />1:1 Attorney in Fact <br />El Trustee <br />El Guardian or Conservator <br />El Other: <br />Signer Is Representing: <br />KARDANI <br />? COMM. ? 1850723 <br />ORANGECOUNTV 2 <br />My Commission Expires <br />June 7 7, 2013 <br />Top of thumb here <br />Signer's Name- <br />El Individual <br />? Corporate Officer -Title(s): - <br />? Partner -? Limited ? General <br />? Attorney in Fact <br />? Trustee <br />? Guardian or Conservator <br />? Other: <br />Signer Is Representing: <br />
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