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Last modified
8/7/2025 2:20:08 PM
Creation date
8/7/2025 11:12:41 AM
Metadata
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Template:
Contracts
Company Name
Shelter Providers
Contract #
A-2021-236-01
Agency
Community Development
Expiration Date
1/1/1900
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CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 1189 <br /> A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document <br /> to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. <br /> State of California <br /> County of 0rckn '� <br /> On 2C2-5 before me, y� n .CCO . N O N f"LAHl <br /> Date Here Insert Nam and Title of Officer <br /> ti <br /> personally appeared }A aro "u R42Z <br /> Name(s)of Signer(s) <br /> who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/are subscribed <br /> to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their <br /> authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity <br /> upon behalf of which the person(s) acted, executed the instrument. <br /> I certify under PENALTY OF PERJURY under the <br /> PubtlC•California laws of the State of California that the foregoing <br /> Notary ubl <br /> EY iSgAAq paragraph is true and correct. <br /> j orange County I <br /> commission 0 24E9063 - WITNESS my hand and icial 1, <br /> My Comm,Espirn May 3,202E <br /> Signature <br /> Place Notary Seal and/or Stamp Above S1 n tur Notary Public <br /> OPTIONAL <br /> Completing this information can deter alteration of the document or <br /> fraudulent reattachment of this form to an unintended document. <br /> Description of Attached Document <br /> Title or Type of Document: <br /> Document Date: Number of Pages: <br /> Signer(s) Other Than Named Above: <br /> Capacity(ies) Claimed by Signer(s) <br /> Signer's Name: Signer's Name: <br /> ❑ Corporate Officer—Title(s): 0 Corporate Officer— Title(s): <br /> ❑ Partner— ❑ Limited ❑ General ❑ Partner— ❑ Limited ❑ General <br /> ❑ Individual ❑ Attorney in Fact ❑ Individual ❑ Attorney in Fact <br /> ❑ Trustee ❑ Guardian or Conservator ❑ Trustee ❑ Guardian or Conservator <br /> ❑ Other: ❑ Other: <br /> Signer is Representing: Signer is Representing: <br /> 02019 National Notary Association <br />
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