ID Acknowledgment-State/Political Subdivision 1

STATE OF ___________________, County of ______________________, ss

On this ________ day of ________________, in the year of _____, before me _______________________________________________, a notary public, personally appeared ________________________________________________________, known or identified to me to be the ______________________________________________ (official capacity) of the ______________________________________________ (name of state, county, city, etc.) that executed the said instrument, and acknowledged to me that such _________________________________________________________________ _______________________________________ (name of state, county, city, etc.) executed the same.

Notary Public: _______________________________________

Residing at: _________________________________________

No guidelines are available for this form at this time.