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LACY, FRANCISCO
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Last modified
11/27/2017 10:13:46 AM
Creation date
11/7/2017 4:50:59 PM
Metadata
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Template:
Contracts
Company Name
LACY, FRANCISCO
Contract #
A-2017-278
Agency
PLANNING & BUILDING
Council Approval Date
10/17/2017
Destruction Year
0
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 <br />.c. .a _ca .a .w .sx .w - .�.,.a m ..es��<.w,,� _ate s,a.+� _w _ ✓� .z,a_ e.ae..n _a .� .aersa��<.c,•_ca..� <br />A notary public or other officer completing this certificate verifies only the identity of the individual who signed the <br />document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. <br />State of Califor is <br />County of Ova <br />On V P <br />Date <br />personally appeared <br />before me, <br />Here Insert Name and <br />Lac �-i . _... .... __ <br />of Signerf4 <br />of the <br />who proved to me on the basis of satisfactory evidence to be the person($) -whose name(s)droare- <br />ubscribed to the within instrumen and acknowledged to me that st @Ahey executed the same in <br />hi�lher4heir authorized capacityQ4, and that by is wftheir signature ron the instrument the person(s), <br />or the entity upon behalf of which the personSK ac ed, executed the instrument. <br />- — — — — — — —� <br />NotaaY PUBLICMA GU ORNIA g <br />LOS ANGELES COUNTY- ci <br />COMMISSION p 2106670 <br />MY COMM. EXPIRES APRIL 12, 2019 <br />I certify under PENALTY OF PERJURY under the laws <br />of the State of California that the foregoing paragraph <br />is true and correct. <br />WITNESS my hand a official seal. <br />Signature Z;�7 <br />Signature of Notary Public <br />Place Notary Seal Above <br />OPTIONAL <br />Though this section is optional, completing this information can deter alteration of the document or <br />fraudulent reattachment of this form to an unintended document. <br />Description of Attached Doc went ?? <br />Title or Type of Document: dd i Document Date: <br />Number of Pages: Signers) Other T an Named Above: <br />Capacity(les) Claimed by Signer(s) <br />Signer's Name: <br />❑ Corporate Officer — Title(s): <br />❑ Partner — ❑ Limited ❑ General <br />❑1 Individual Cl Attorney in Fact <br />❑ Trustee LJ Guardian or Conservator <br />❑ Other: <br />Signer Is Representing: <br />Signer's Name: <br />❑ Corporate Officer — Title(s): <br />❑ Partner — ❑ Limited ❑ General <br />❑ Individual CI Attorney in Fact <br />❑ Trustee I I Guardian or Conservator <br />❑ Other: <br />Signer Is Representing: <br />02014 National Notary Association • www.NationaiNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907 <br />
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