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Stateof ............................................ , <br />Countyof ... .. . . . . . . . . . .. . . . ......... . . . . .. . . . . . . . . . <br />The foregoing instrument was acknowledged before me on . . . . . . . ... . . . ...... ..... . . . . . . . . . . . .. . ...... ............... . <br />by ....................................................................................................................................... <br />......................................................................... <br />Stateof ............................................ <br />Countyof ... . . . . .. . . . . . . . . .. . . . . . . . .. .. ..... . . .. ... . <br />The foregoing instrument was acknowledged before me on . ... .. . . . . . . . .. . . . . . . . . ...... . ....... .. . . . . . . . . . . . . . . . ...... <br />by ....................................................................................................................................... <br />......................................................................... <br />