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Individual Acknowledgement

State of __________.

County of _________.

On the [Date], before me personally appeared _______________, to me known to be the individual described in and who executed the document annexed hereto and who executed same in my presence or acknowledged said signature as a true and free act and deed, before me.

On [Date] before me, ____________________, personally appeared _______________, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

WITNESS my hand and official seal.

Signature

Affiant Known Produced ID

Type of ID

(Seal)