On the day of ,
( y e a r ), before me personally appeared
, who being by me duly sworn, did depose and say that he is
, the corporation described in and
which executed the annexed document; that he knows the seal of said corporation; that the seal
affixed is such corporate seal; that it was so affixed by order of the Board of Directors of said
corporation, and that he signed his name thereto by like order.
On 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.
Affiant _____Known _____Unknown