“State of .............

County of .............

On this . . . . . . day of. . . . . . . . . . . . . ., 20. . . . . ., before me, . . . . . . . . . . . . . ., a Notary Public, (or before any officer within this State or without the State now qualified under existing law to take acknowledgments), duly commissioned, qualified and acting, within and for said County and State, appeared in person the within named . . . . . . and . . . . . . . . . ., (being the person or persons authorized by said corporation, [business trust, estate, partnership, limited liability company, association, joint venture, or other legal entity] to execute such instrument, stating their respective capacities in that behalf), to me personally well known (or satisfactorily proven to be such person), who stated that [he, she, or they] was [were] the . . . . . . [and . . . . . . ] of the . . . . . ., a corporation [business trust, estate, partnership, limited liability company, association, joint venture, or other legal entity], and was [were] duly authorized in [his, her, or their] respective capacity [capacities] to execute the foregoing instrument(s) for and in the name and behalf of said corporation [business trust, estate, partnership, limited liability company, association, joint venture or other legal entity], and further stated and acknowledged that [he, she, or they] had so signed, executed, and delivered said foregoing instrument for the consideration, uses, and purposes therein mentioned and set forth

“IN TESTIMONY WHEREOF, I have hereunto set my hand and official seal this . . . . . . day of . . . . . . . . . . . . . ., 20 . . . . . .

. . . . . . . . . . . . .

(Notary Public)”