CERTIFICATE OF SERVICE

Republic of _____________________ )
Subscribed and affirmed )
County of ____ )

I, ________________________________. The undersigned. Mailer server. Being of sound mind and under no duress do you hear by certify,
attest, and affirm. That the following facts are true and correct, to wit:

1. That on _____ Day of ___________________, 20___, on behalf of (name______________________. A natural person, the
undersigned personally deposited the following documents listed below inside the envelope, sealed them, and transmitted them via
the carrier indicated in item 2 below, to wit:

Item # Document Description Number of pages

Total of__________ documents with combined total of_____________ pages

2. That I personally mailed said document(s) via. (Check those which apply)

____ United States postal office by regular mail postage prepaid.

____ United States Postal Office by Certified Mail # ____________________________________

return receipt requested.

____ United States Postal Service. UPS. Tracking Number # ______________________________

____ Federal Express, Tracking Number # ____________________________________________

____ Other (specify) _____________________________________________________________

At said City and State, one (1) complete set of ORIGINALS/COPIED (circle one) documents, as described in item 1
above, properly enveloped and addressed to (addressee and address):

__________________________________ OPTIONAL_____________________________________

Though below is not required by law. It may prove valuable to person(s)relying on the document and could
prevent fraudulent removal and reattachment of this form to another document.
Right Thumbprint of Right Thumbprint of
Signer # 1 Signer # 2

Further Description of Any Attached Documents.

Title or Type of Document: _______________________________

Document Date: _________ Number of Pages: _______________

Signer(s) Other than above: ________________________________

CERTIFICATE OF SERVICE

3. That I am at least 18 years of age.

4. That I am not related____________________ blood, marriage, adoption, or employment, but serve as a

"Disinterested third party" (herein "Server"); and further,

5. That I am in no way connected to, or involved in or with, the person and/or matter at issue in this instant
action.

I now affix my signature to these affirmations.

(Signature): ___________________________________ Mailer/Server

(Printed name): ________________________________

NOTARY PUBLIC'S JURAT

BEFORE ME, the undersigned authority, a Notary Public, of the County of

____________________Republic of ___________________this____day of_______________ 20___

_________________________________mailer/server did appear and was identified by driver's license and who,
upon first being duly sworn and/or affirmed, deposes, and says that the afore going asseveration is true to the
best of his/her knowledge and belief.

WITNESS my hand and official seal.

/s/_____________________________________________SEAL:
Notary Public
My Commission Expires On: