"STATE/COMMONWEALTH OF {CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@} COUNTY/BOROUGH/PARISH OF {CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@}
"
"BEFORE ME, the undersigned authority, on this day personally appeared
"\a and \b, known to me to be the person(s) whose name(s) is(are)
"subscribed to the foregoing instrument, and acknowledged to me that
"they executed said instrument for the purposes and consideration
"therein expressed.
"
"GIVEN under my hand and seal of office on this {CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@}{CBM-@} day of