Fill and Sign the Uniform Acknowledgment Act Pennsylvania Department of State

PENNSYLVANIA Individual STATE OF COUNTY OF On this ____ day of ____, ____, before me, ____, the undersigned officer, personally appeared ____, known to me to be the person whose name is subscribed to the within instrument and acknowledged that he executed the same for the purposes therein contained. In witness whereof I hereunto set my hand and official seal. Notary Public in and for the State of Printed Name: Commission Expires: Corporate STATE OF COUNTY OF On this ____ day of ____, ____, before me, ____, the undersigned officer, personally appeared ____, who acknowledged himself to be the ____ of ____, a corporation, and that he, as such ____, being authorized so to do, executed the foregoing instrument for the purposes therein contained, by signing t he name of the corporation by himself as ____. In witness whereof I hereunto set my hand and official seal. Notary Public in and for the State of Printed Name: Commission Expires: Partnership STATE OF COUNTY OF On this the ____ day of ____, ____, before me, ____, the undersigned officer, personally appeared ____, a ____ partner (general, managing, limited, etc.), of ____ (name of partnership), and acknowledged that he executed the same as an act of the partnership. In witness whereof I hereunto set my hand and official seal. Notary Public in and for the State of Printed Name: Commission Expires: Agent or Attorney in Fact STATE OF COUNTY OF On this the ____ day of ____, ____, before me, ____, the undersigned officer, personally appeared ____, known to me to be the person whose name is subscribed as attorney in fact for ________, and acknowledged that he executed the same as the act of his principal for the purposes therein contained. In witness whereof I hereunto set my hand and official seal. Notary Public in and for the State of Printed Name: Commission Expires: