COMMUNITY DEVELOPMENT AGENCY/LATINO HEALTH ACCESS 1B-2010

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CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of © PANCRE; On 11 1( ?a C U before me, _V I J AMY N () TA FY C9 a L, i C (Here insert name an title of the officer) personally appeared AmU--tcA --- who proved to me on the basis of satisfactory evidence to be the person whose namdKis7af-csubscribed to the within instrument and acknowledged to me that ha/.,she/they-executed the same in'hAsLher/thrk_authorized capacity, and that bylii4er/thtigsignaturd?on the instrument the person?or the entity upon behalf of which the persolr(. acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WA= WITNESS my hand and official seal. WTARY Ua BUC CAIROFM COMMISSION flow= t ORANGE COUNTY Comm. 8 201 (Notary Seal) 5' f otary Public ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT S c c: a a`I D A vh C-T-1 Din c.=-t4 J- -Co (Title or description of attached document) (Title ur description of attached document continued) Number of Pages 3 Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER ? Individual (s) ? Corporate Officer (Title) ? Partner(s) ? Attorney-in-Fact ? Trustee(s) ? Other' INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. Wshe/they is /era) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re-seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to, a different document. Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e: CEO, CFO, Secretary). • Securely attach this document to the signed document cvvo version L..vr.v v12.1U.U7 800-873-9865 www.NotaryClasses.com