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5912.ARM
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1991-06-27
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900b
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62 lines
/* Para 6102: Closer, poa */
_______________________________________________
@001- Principal
Social Security Number: @614
Witnesses:
_____________________________________________________________
_____________________________________________________________
STATE OF @612
COUNTY OF @613
@001, and the witnesses listed above appeared before me and
stated that:
1. @001 executed this instrument in their presence, and that
they witnessed this instrument in each other's presence, and
at @001's request.
2. That @001 appeared to be a lawful age, of sound mind, and
willingly executed this document, on this the _____ day of
_______________________________, 19__________.
_________________________________________________
Notary Public