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Public Highway At-Grade Crossing 03/01/13 Standard Form Approved, AVP-Law <br /> <br />ACKNOWLEDGMENT <br /> <br /> <br />STATE OF <br /> ) ss: <br />COUNTY OF ) <br /> <br /> <br />On this ____ day of _______________, 20_____, before me, a Notary Public in and for said County and State, <br />personally appeared <br /> _________________________________________________________________________________ (Name of Individual Executing Agreement on Behalf of the Political Body) <br /> <br />who is the ________________________________________________________________________ <br /> (Title of Individual Executing Agreement on Behalf of the Political Body) <br />of the , and who is personally known to me (or proved to me on the basis of <br />satisfactory evidence) to be the person whose name is subscribed to in the within instrument, and <br />acknowledged to me that he/she executed the same in his/her authorized capacity, and that by his/her <br />signature on the instrument the person, or the entity upon behalf of which the person acted, executed <br />the instrument. <br /> <br />WITNESS my hand and official seal. <br /> <br /> <br /> <br /> <br />↑ (Affix Notary Seal Here) ↑ <br />______________________________________ <br />Notary Public for and in said State <br /> <br />My commission expires: _____________________ <br /> (Expiration Date) <br /> <br />