)ss.:
County of _____________________)
On the _______ day of ___________ in the year _____, before me, the
undersigned notary public, personally appeared
_________________________, personally known to me or proved to me on the
basis of satisfactory evidence to be the individual(s) whose name(s) is
(are) subscribed to the within instrument and acknowledged to me that
he/she/they executed the same in his/her/their capacity(ies), and that
by his/her/their signature(s) on the instrument, the individual(s), or
the person upon behalf of which the individual(s) acted, executed the
instrument.
____________________________________________
Notary Public
Part III. Statement of Interpretation/Translation
I am bilingual in English and ____________ and have translated or
interpreted this document to the best of my ability for the signer
above.
_________________________________________
(name of interpreter/translator)
_________________________________________
(signature of interpreter/translator)
___________________
(date) Acknowledgement
State of ______________________)