Notarized Legal Application

NOTARIZED LEGAL APPLICATION

This Notarized Legal Application is executed on the day of , by Applicant Name: whose address is (hereinafter "Applicant"), in favor of Recipient Name: with principal address (hereinafter "Recipient").

RECITALS

WHEREAS, Applicant seeks to submit a formal request to Recipient for the purpose described as ; and

WHEREAS, Applicant affirms that the statements, facts and documents provided in connection with this Application are true, accurate and complete to the best of Applicant's knowledge and that Applicant understands this Application may be relied upon by Recipient in granting, denying, or otherwise taking action in respect of the requested relief; and

WHEREAS, Applicant intends that this Application be notarized, sworn to, and delivered to Recipient for official processing and recordation as required.

NOW THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, Applicant and Recipient agree as follows:

1. DEFINITIONS

1.1 "Application" means this Notarized Legal Application and all documents, affidavits, exhibits and attachments submitted in support hereof.

1.2 "Applicant" and "Recipient" have the meanings set forth in the opening paragraph and include their successors and permitted assigns.

2. APPLICATION, REQUESTED ACTION AND ATTACHMENTS

2.1 Applicant hereby requests the following action or relief from Recipient:

2.2 Applicant submits the following attachments as part of this Application (list documents and indicate inclusion):

3. REPRESENTATIONS AND WARRANTIES

3.1 Applicant represents and warrants to Recipient that: (a) Applicant has the legal capacity to execute and deliver this Application; (b) all statements made herein and in any supporting documents are true, complete and correct in all material respects; and (c) there are no known pending actions, liens, or encumbrances that would materially impair Applicant's ability to obtain the relief requested.

4. OATH, NOTARIZATION & AUTHORIZATION

4.1 Applicant acknowledges that this Application must be signed under oath or affirmation before a duly commissioned Notary Public or other officer authorized to administer oaths. Applicant hereby submits to the jurisdiction of any competent authority for the purpose of notarization and verification of identity.

4.2 Applicant swears or affirms under penalty of perjury that the statements and representations contained in this Application and in any attachments are true and correct. I swear/affirm this is true under penalty of perjury.

4.3 Notarization particulars (for official use and record):

5. PRIVACY, DISCLOSURE AND USE OF INFORMATION

5.1 Applicant authorizes Recipient and its agents to use, store, copy and disclose information necessary to process this Application, including disclosure to governmental authorities when required by law. Such information will be used solely for the purpose of evaluating and processing the Application unless otherwise required by law.

5.2 Applicant hereby waives any claim against Recipient for actions taken in good faith reliance on the representations contained in this Application and accompanying documentation.

6. FEES; PAYMENT

Applicant acknowledges responsibility for any fees associated with processing this Application and agrees to promptly pay all required fees pursuant to Recipient's established procedures. Applicant acknowledges fee responsibility.

7. NOTICES

All notices required or permitted under this Application shall be in writing and delivered by hand, certified mail, or other delivery service to the addresses set forth below or to such other address as a party provides in writing pursuant to this provision and shall be deemed received when delivered.

8. AMENDMENTS; WAIVER; COUNTERPARTS

8.1 This Application may be amended only by a written instrument executed by both Applicant and Recipient. No failure or delay by any party in exercising any right hereunder shall operate as a waiver thereof, nor shall any single or partial exercise of any right preclude any other or further exercise of that right.

8.2 This Application may be executed in counterparts, each of which shall be deemed an original but all of which together shall constitute one and the same instrument. Signatures transmitted by electronic means shall be deemed binding for all purposes.

9. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

9.1 Governing Law. This Application shall be governed by and construed in accordance with the laws of the State of without regard to its choice of law principles.

9.2 Entire Agreement. This Application, together with any attachments expressly incorporated herein, constitutes the entire agreement between Applicant and Recipient with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, representations and understandings of the parties, whether written or oral.

9.3 Severability. If any provision of this Application is held to be invalid or unenforceable, such provision shall be enforced to the maximum extent permitted by law and the remaining provisions shall remain in full force and effect.

CERTIFICATION

By signing below, Applicant certifies under penalty of perjury that the foregoing statements are true and accurate and that Applicant understands that any material misstatement, omission or falsification may subject Applicant to criminal or civil penalties under applicable law.

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