Notary Public of New York

Individual Acknowledgement

State of New York
County Of ________________

The foregoing instrument was acknowledged before me this _______ of ______________________, 20_______ by

___________________________________________________ , who is personally known to me or who has produced (type of identification) as identification.

____________________________________________
Signature of person taking acknowledgment

____________________________________________
Name typed, printed or stamped

____________________________________________
Title or rank

____________________________________________
Serial number, if any

Initials:  __________.

Date:     __/__/ 20___.

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