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CLOVER FAMILY TRUST, HSSM 2006 FAMILY TRUST, AND REZA FASSIHI-2011
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CLOVER FAMILY TRUST, HSSM 2006 FAMILY TRUST, AND REZA FASSIHI-2011
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Last modified
4/23/2021 3:23:33 PM
Creation date
3/10/2011 5:30:21 PM
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Contracts
Company Name
CLOVER FAMILY TRUST, HSSM 2006 FAMILY TRUST, AND REZA FASSIHI
Contract #
A-2011-034
Agency
PUBLIC WORKS
Council Approval Date
2/22/2011
Destruction Year
p
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III I CALIFORNIA ALL-PURPOSE III <br />CERTIFICATE OF ACKNOWLEDGMENT <br />State of California <br />County of <br />On PC, 20 before me, VJ (:k kt 1 e Qk-' 1" be5z Lje uQO( h <br />(here insert name and1 itle of the officer) <br />personally appeared T41'ch ®�C �1 O.0.E Q, Aja <br />who proved to me on the4Asis of satisfactory evidence to be the persono whose namcas 44© subscribed to <br />the within instrument and acknowledged to me that ke/sheA�ffD executed the same in Iris/her�iie authorized <br />capacity( es , and that by his/hej(2p signatureG on the instrument the persor%G), or the entity upon behalf of <br />which the person#9 acted, executed the instrument. <br />I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph <br />is true and correct. <br />�DANIELA BORBE <br />WITNESS my hand and official seal. �pp Comm.R 1878676 <br />NOTARY PUBLIC-CALIFORNIA <br />l' fff • ORANGE COUNTY <br />MY Comm. Exp, JAN. 914t " <br />Signature of Notary Public (Seal) <br />ADDITIONAL OPTIONAL INFORMATION <br />DESCRIPTI ONE F THE ATTACHED DOCUMENT <br />(Title or description o Cached document) <br />(Title or description of attached document turned, <br />Number of Pages Document Date <br />(Additional information) <br />CAPACITY CLAIMED BY THE SIGNER <br />❑ Individual (s) <br />❑ Corporate Officer <br />❑ Partner(s) <br />❑ Attomey-in-Fact <br />❑ Trustee(s) <br />❑ Other <br />INSTRUCTIONS FOR COMPLETING THIS FORM <br />Any acknowledgment completed in California must contain verbiage exactly as <br />appears above in the notary section or a separate acknowledgment form must be <br />properly completed and attached to that document. The only exception is if a <br />document is to be recorded outside of California. In such instances, any alternative <br />acknowledgment verbiage as may be printed on such a document so long as the <br />verbiage does not require the notary to do something that is illegal for a notary in <br />California (i.e. certifying the authorized capacity of the signer). Please check the <br />document carefully for proper notarial wording and attach this farm if required. <br />• State and County information must be the State and County where the document <br />signer(s) personally appeared before the notary public for acknowledgment. <br />• Date of notarization must be the date that the signer(s) personally appeared which <br />must also be the same date the acknowledgment is completed. <br />• The notary public must print his or her name as it appears within his or her <br />mmrssion followed by a comma and then your title (notary public). <br />• Prin he names) of document signer(s) who personally appear at the time of <br />• Indicate the ect singular or plural forms by crossing off incorrect forms (i.e. <br />he/she/Rhey;- is / or circling the correct forms. Failure to correctly indicate this <br />information may le rejection of document recording. <br />• The notary seal impres n must be clear and photographically reproducible. <br />Impression must not cover t or lines. If seal impression smudges, re -seal if a <br />sufficient area permits, otherwis omplete a different acknowledgment form. <br />• Signature of the notary public must tell the signature on file with the office of <br />the county clerk. <br />Additional information is not required but could help to ensure this <br />acknowledgment is not misused or attached to a different document. <br />Indicate title or type of attached document, number of pages and date. <br />Indicate the capacity claimed by the signer. If the claimed capacity is a <br />corporate officer, indicate the title (i.e. CEO, CFO, Secretary). <br />• Securely attach this document to the signed document <br />
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