BLANK JURAT FORM

State of California
County of ______________________ } ss.

Subscribed and sworn to (or affirmed) before me on on this __________________ day of _____________________, 20_____, by __________________________, proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.

.                                                                                              ___________________________________
(seal)                                                                                      Signature


HOW TO COMPLETE THE JURAT FORM

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

Subscribed and sworn to (or affirmed) before me on on this Day day of Month, 20Year , by Name(s) of person(s) who appeared, proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.

Notary Public Seal Imprint                                              Notary Public Signature
(seal)                                                                                      Signature


SAMPLE COMPLETED JURAT FORM

State of California
County of San Francisco} ss.

Subscribed and sworn to (or affirmed) before me on this 1 day of January, 2008, by Ulysses S. Grant, proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.

                                           Bob D. Notary
(seal)                                                                                      Signature