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[Notary block for Corporation, Partnership, Limited Liability Company] <br />STATE OF ) <br />) ss. <br />COUNTY OF ) <br />This instrument was acknowledged before me on by , [title] <br />of a [type of entity], on behalf of <br />said [name of entity]. <br />Dated: <br />(Use this space for notary stamp /seal) <br />[Notary block for Individual] <br />STATE OF ) <br />) ss. <br />COUNTY OF ) <br />This instrument was acknowledged before me on by <br />Dated: <br />(Use this space for notary stamp /seal) <br />[Notary block for Tenant] <br />STATE OF <br />COUNTY OF <br />Notary Public <br />Print Name <br />My commission expires <br />Notary Public <br />Print Name <br />My commission expires <br />) ss. <br />I certify that I know or have satisfactory evidence that <Director Name> is the person who appeared before <br />me, and said person acknowledged that he signed this instrument, on oath stated that he was authorized to execute <br />Site Number: Error! Reference source not found. <br />Site Name: <Site Name> <br />Market: <Market> <br />Version 10 -2 -01 <br />