BLANK ACKNOWLEDGMENT FORM

State of California
County of _______________} ss.

On ______________ before me, (here insert name and title of the officer), personally appeared ______________, who 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 signatures(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.


HOW TO COMPLETE THE ACKNOWLEDGMENT FORM

State of California
County of Place where document signer appeared } ss.

On Date document signer appeared before me, Commission Name and Title of Notary Public, personally appeared Name(s) of document signer(s), who 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 signatures(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Notary Public Signature
Notary Public Seal Imprint


SAMPLE COMPLETED ACKNOWLEDGMENT FORM

State of California
County of San Diego} ss.

On January 1, 2000 before me, Bob Smith, Notary Public, personally appeared Adam Johnson, who 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 signatures(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Bob Smith