BEFORE ME, this _________________ in the ________________, personally appeared
the parties with their respective proofs of identity, known to me to be the same persons who executed the foregoing instrument consisting of two ( 2 ) pages including this page , and acknowledged to me that the same is his/her free act and deed.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my notarial seal on the place above-written.