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(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 /> Before me, a Notary Public in and for said County and State, personally appeared <br /> , the of <br /> , a(n) , Owner(s) of <br /> the real estate described above who acknowledged the execution of the foregoing instrument in <br /> such capacity and who, having been duly sworn, stated that any representations therein contained <br /> 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 /> This instrument was prepared by Timothy P. Staub, Zoning Specialist. <br /> Page 4 of 5 <br />