ACKNOWLEDGEMENT STATE OF ______________[1] } COUNTY OF _____________[2] } Before me, a Notary Public in and for said County and State, personally appeared _______________________________[3], who acknowledged that he did sign the foregoing instrument and that the same is his free act and deed. In Testimony Whereof I have hereunto set my hand and official seal, at ________________________[4], this _______[5] day of _________[6], 20____[7]. _________________________________________ Signature of Notary Public My commission expires on:________________[8]