NEW YORK UNIFORM FORM CERTIFICATE OFACKNOWLEDGMENTAND OF PROOF OF EXECUTION BY A SUBSCRIBING WITNESS

For Effective Dates See
Current Developments
Issued October 14, 1998

UNIFORM FORM CERTIFICATE OF ACKNOWLEDGMENT(Within New York State)

State of New York )
County of _______ ) ss.:

On the ____ day of ________ in the year ____ before me, the undersigned, 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.

_____________________________

Signature and Office of individual

taking acknowledgment

UNIFORM FORM CERTIFICATE OF ACKNOWLEDGMENT
(Outside of New York State)

State, District of Columbia, Territory, Possession, or Foreign Country

_____________________ ) ss.:

On the __ day of _______ in the year _____ before me, the undersigned, 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), 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. _____________________________

(Signature and office of individual
taking acknowledgment.)

UNIFORM FORM CERTIFICATE OF PROOF OF EXECUTION BY A SUBSCRIBING WITNESS
(Within New York State)

State of New York )
County of _______ ) ss.:

On the ____ day of ________ in the year ____ before me, the undersigned, personally appeared ________________________, the subscribing witness to the foregoing instrument, with whom I am personally acquainted, who, being by me duly sworn, did depose and say that he/she/they reside(s) in ______________________ (if the place of residence is in a city, include the street and street number, if any, thereof); that he/she/they know(s) ________________________ to be the individual described in and who executed the foregoing instrument; that said subscribing witness was present and saw said ________________________ execute the same; and that said witness at the same time subscribed his/her/their name(s) as a witness thereto.

_____________________________

Signature and Office of individual
taking proof

UNIFORM FORM CERTIFICATE OF PROOF OF EXECUTION BY A SUBSCRIBING WITNESS (Outside of New York State)

State, District of Columbia, Territory, Possession, or Foreign Country

______________________) ss.:

On the __ day of _____in the year ____before me, the undersigned, personally appeared _________, the subscribing witness to the foregoing instrument, with whom I am personally acquainted, who, being by me duly sworn, did depose and say that he/she resides in ___________(if the place of residence is in a city, include the street and street number, if any, thereof); that he/she knows ________ to be the individual described in and who executed the foregoing instrument; that said subscribing witness was present and saw said _______ execute the same; that said witness at the same time subscribed his/her name as a witness thereto. {(Following text is optional) and that said subscribing witness made such appearance before the undersigned in ______________. (Insert the city or other political subdivision and the state or country or other place in which the proof was taken.)}

_____________________________

(Signature and office of individual
taking proof.)