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NO $103
<br />Stage of
<br />County of
<br />On__._ before
<br />BATE
<br />personally appeared
<br />0 personally known to me - OR » [7 proved
<br />THE DOCUMENT
<br />IMMMMMME s
<br />tT
<br />(1-2) NAME OF STATE and NAME OF COUNTY in
<br />which Notary performs notarization.
<br />(s) DATE OF NOTARIZATION. Actual month, day and
<br />you In which alarmist appear(s) before Notary in
<br />named state and county.
<br />(d) NAME &TITLE OF NOTARIZING OFFICER. In the
<br />man of a.Notary, "Notary Public" would ad the ffie.
<br />(5) )TAME OF SIGNERS) appearing before Notary.
<br />Initials andspalfidg of all names should agree with
<br />document stgnatura and to does.
<br />(iD CHECK LEFT SOX it signer IS personally known to
<br />Notary. CHECK RIGHT BOX tt Notary laramit essignor
<br />through either (a) tO cards or to) oath of d[edible
<br />wime3a:
<br />(7) CROSS OUT inapplicable letters and words
<br />fpamon(s), name(s), faces, holshethey. hisrhart their,
<br />capnry(fos), slgnaftuok)j, or CIRCLE applicable
<br />words to agree with number and sex of signers) in
<br />space $.
<br />the
<br />m
<br />OPTIONAL SECTION Aii-iiiiiiia
<br />CAPACITY CLAIMED BY SIGNER
<br />Though statute does net require the Notary to
<br />fin in the data below, doing so may prove
<br />arneuaiNa to parsons!raying on the res mom
<br />-it' JMEOOC NOTARII aU '� i[- INDIVIDUAL
<br />L,.IGK)RPORATEOFFICER(S)
<br />`v+smctbl ur sicNt:ntal- ��: - ...
<br />1111.Eih
<br />me OR the basis of satistacto[y V' ence PARTNER(S) 0 LIMITED
<br />a the person(s) whose nam8(s ' r [ GENERAL
<br />cribed I6 the Wl ' instrument an E] ATTORNEY -IN -FACT
<br />fledged to me the she/they ex ted © TRUSTEE(S)
<br />same in �` r if out Ized GUARDIANICONSERVATOR
<br />acity(ie nd at 1 r/their ©oTr+ER.
<br />9NIre to A the nirYtPn# no Qnnlel
<br />SIGNER IS REPRESENTING:
<br />NAME OF MRSCN(S) OF 5NTrrYR*St
<br />1
<br />OF'PAGES DATEOFDOCUMENT-
<br />} OTHER THAN NAMED ABOVE
<br />(8) SI{#NATURE OF NOTARY cauvw+nlnaxu,wr
<br />exactly as name appears on
<br />dainmtasloning papers. in Space 4
<br />and Wisest.
<br />(0) NOTARY SEAL IMPRINT, penwmslz�aaae-.-..
<br />dearly affixed
<br />.SPACES 10-12OPTIONAL. While e.
<br />law do ssn'to¢Gpate the Notary to if]
<br />in this Orval data, lit omission may
<br />:Cause the document to be question.
<br />ad or challenged.
<br />(10) CHECK APPROPRIATE BOX.
<br />to indicate whether signer is signing
<br />as individual on his or her own mace+ns.:eeiwsrce
<br />behalf, was Corporate oficer. vmzzv uvr x.
<br />(WRITE IN CORPORATE TITLE),^,.
<br />Partner, anomhy-inac4 trustee,
<br />guardiaNaansurvator, or in another capaaily.
<br />If 1) DESCRIPTION OF OTHER CAPACITY(IES),A
<br />single capacity,, Such as sunanRt,-may ba Indicated
<br />here: at a multiple capacity, such as, 'corporate office,
<br />signing toe partnership fn which cor a gion is padner,"
<br />(12) NAME OF PERSON DR LEGAL ENTtTY.fact
<br />signor is representing, it could, for example, be name of
<br />absent j ereon represented by a(tameyda-fact. It could
<br />be name of condominium conscience, such do 'Blue
<br />Lagoon Condo Assn." Or, it could be multiple: entities,
<br />such as"-XYZ Corp., partner In Mutual Enterprises, a
<br />Partnership.,
<br />SPACES 13A6 OPTIONAL Omission of data hero will
<br />not affect document's validity. However. by completing
<br />brew spaces, Ranges can deloriraudulon malinee-
<br />mont of Cardficat r to an Restaurant t document.
<br />{13) TITLE OR TYPE OF DOCUMENT NOTARIZED,
<br />such as'Dood of TnodL'
<br />vnMas&aaR va�ttrtt�
<br />[Eu".�as C3wr;Fs
<br />Clm*+.xw-s-
<br />pmeeecc
<br />G >?n
<br />Ovv�
<br />awaen u nsuumrira
<br />em.r... rlw�aex
<br />(ta) NUMBER OF PAGES IN DOCUMENT
<br />MOTARRED. Do oat count c ulliflude, as a papa.
<br />(Ts) DATE OF DOCUMENT NOTAPMEO. Most, bm
<br />not all documents will have data, usually at tap of
<br />fallowing signature Ones: this rmrr ma@y indicates date
<br />of signing. It rrone, mean; 'NO DATE,"
<br />(16) SIGNEWS) DIM THAN NAMED IN SPACE 5.
<br />Since all signors may not be named on some notarial
<br />canincato, here insert namoRd at slgnet(s) that
<br />appear(a) at will appear on other certificates --as
<br />many as apace atlows.at none, kardY.'NO O iHER
<br />SIGNERS.'
<br />COPYRIGHT R`1993
<br />NATIONAL NOTARY ASSOCIATION
<br />8236 Remmat Am., P.O. Box 7184
<br />Canoga Park, CA 91309^7184
<br />Telephone: 810,7134000
<br />P12607
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