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(Organization Owner) <br /> By <br /> Printed <br /> Title <br /> (Individual Acknowledgment) <br /> STATE OF ) <br /> ) SS: <br /> COUNTY OF ) <br /> Before me, a Notary Public in and for said County and State, personally appeared <br /> , Owner(s)of the real estate described above who <br /> acknowledged the execution of the foregoing instrument and who, having been duly sworn, <br /> stated that any representations therein contained are true. <br /> Witness my hand and Notarial Seal this day of <br /> Signature <br /> Printed <br /> County of Residence <br /> My Commission expires: <br /> (Organization Acknowledgment) <br /> STATE OF ) <br /> ) SS: <br /> COUNTY OF ) <br />