“State of .............
County of .............
On this the . . . . . . day of . . . . . . . . . . . . . ., 20. . . . . ., before me, . . . . . . . . . . . . . ., the undersigned officer, personally appeared . . . . . . . . . . . . . ., known to me (or satisfactorily proven) to be the person whose name is subscribed as attorney in fact for . . . . . . . . . . . . . ., and acknowledged that [he or she] executed the same as the act of [his or her] principal for the consideration, uses, and purposes therein contained
IN TESTIMONY WHEREOF I hereunto set my hand and official seal
. . . . . . . . . . . . .
. . . . . . . . . . . . .
Title of Officer.”
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