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the execution of the foregoing instrument in such capacity 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 />I affirm under the penalties for perjury, that I have taken reasonable care to redact each Social <br />Security number in this document, unless required by law. <br />This instrument was prepared by Matthew Chappuies. <br />r <br />