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'r~~~.~u-~~g`v.~i.~~L <~~gl~'®YV ~~~J~71VA1L1V~ <br />State of C`aliFornia _ ~~ <br />County of ~ /.;~~„ ~~ -_ S S. <br />On ~_, - ~ ~ ,before lne, ,~,~ ,.y ~- ;,~,,f~~ ;~ ,Notary Public, <br />.~_:r:_ <br />personally appeared - ~,~,~„; /~ ~ ~ fy <br />- - -~- ,who pro~~ed t~ me on the <br />basis of satisfactor~~ eti ide~ee to be the erson(s) whose name(s) is/are subscribed to the within instrument <br />and acknowledbed to me that/she/they executed the <br />same in his/her/their authorized ca acit (ies), and that <br />by,1~i (her/their signature(s) on the instrument the <br />person(s), or the entity upon behalf of which the <br />person(s) acted, executed the instrument. <br />I certify under PENALTY OF PERJURY under the <br />laws of the State of California that the foregoing <br />paragraph is true and correct. <br />WITN SS my hand and official seal. <br />~~ ~~ <br />NOTARY'S SIGNATURE, <br />PLACE\~i7~k1"SE_-1L IA ~[3UVESP_~CE <br />OPTIONAL INFORMATION <br />The infornlation below is optional. However, it may prove valuable and could prevent fraudulent attachment <br />of this form to an unauthorized document. <br />CAPACITP CL_~I~~IED 61~ SIG_ti~ER (PRINCIPAL) <br />^ INDIVIDUAL <br />^ COr_?OP,.aTF CiFFICt~R <br />^ PARTNER(S) Trr~Ers~ <br />^ ATTORNEY-IN-F.ACT <br />^ TRUSTEE(S i <br />^ GUARDIAV~~COV'S~P.t-TOR <br />^ OTHER: <br />DESCRIPTION OF ATTACHED DOCUMENT <br />~~ ~'.~ ~.~ ~.~. T _ Tv C~~v,~~T-,~~ .ter S <br />TI"I'LE QR TYPE GF DOCUii~tENT <br />NUMBER OF PAGES <br />DATE OF DOCUMENT <br />SIGNER (PRINCIP_~,L) IS REPRESENTING: <br />N;~nir c~Fr~~.rtsc~~,~,c,R F~rrn,;_ <br />OTHER <br />RIGHT <br />THUMBPRINT <br />OF <br />SIGNER <br />:1PA01?J08 ~'~OTAKS'BUNpS,SUPPLIESANDPORMS~tTHTTP://WW~1CV.4LL61'-SIL-RRA.C011 5~?Jp5-OpOg~ALLEI'-SILRfL11NSURANCE <br />