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<br />State of <br />County of <br /> <br />) <br />) <br /> <br />On <br /> <br />, before me, <br /> <br />, Notary Public, <br /> <br />personally appeared <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 <br />in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the <br />person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. <br /> <br />(here insert name and title of the officer) <br /> <br />I certify under PENALTY OF PERJURY under the laws of the State of <br />foregoing paragraph is true and correct. <br /> <br />that the <br /> <br />WITNESS my hand and official seal. <br /> <br />Signature <br /> <br />(seal) <br /> <br />-5- <br />