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n <br />arae o lan <br />By: <br />Address: <br />Title: <br />Telephone no.: <br />Contact Person: <br />l. For an acknowledgement in an individual capacity: <br />State of Washington 1 <br />ss. <br />County of � <br />I certify that I know or have satisfactory evidence that <br />signed this instrument and acknowledged i± to be <br />(his/her) free and voluntary act for the purposes mentioned in the <br />instrument. <br />Dated <br />(Seal or Stamp) Signature of <br />Notary Public _ <br />Title <br />Pty appointment expires <br />2. For an acknowledgement in a representative capacity: <br />State of Washington ) <br />ss. <br />County of � <br />I certify tiiat I know or have satisfactory evidence <br />that signed this instrument, <br />'(Name of Person) <br />on oath stated (he/she) was autliorized to execute the instrument and <br />acknowledged it as the <br />(Type:of.Autliority,iE.G., Officer;�Trustee,'etc.) <br />of <br />(Name oi ParLy on Behalf of Whom Instrument was Executed) <br />Q� <br />