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201�U�71� <br />Signed this _�l day of h( d lA�c.wi�e,(' , 20.1� <br />Lienor: �l�lAV�S C' o�S-�r1���_r��► : ✓1 C- <br />BY� � , �2—�' �,� <br />Officer orAgent <br />State of s�'�C 0��- <br />County of -�'�.�� } <br />On N��'������ �� , 20 �� before me, ��SSCS.LCUu �• �u����, <br />appeared �� ��'��.�c�. <br />personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are <br />subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized <br />capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the <br />person(s) acted, executed the instrument. <br />WITNE55 my hand and official seal. <br />Signature _ ���r -F�.�i-Z�.� <br />Signature of Notary <br />Affiant Known `le Produced ID <br />Type of ID "�l�t �r1'�S �-�C.,'`��, <br />(Seal) <br />�HtAI. NOl'N111- S�ta � � <br />sT�r a �cw+ <br />My Canm. Et�p. Maq 10,�18 <br />Page 2 <br />mnv.soaates.com OO Z004, Socrates Media, LLC <br />LF136 • Rev. 04/04 <br />