“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), appeared the within named . . . . .
[and . . . . . . . . . .], to me personally well known (or satisfactorily proven to be such person), who 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)”
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