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______________________________ _______________________________
Signature of Assignor Signature of Assignor
State of__________________________
County of________________________
On this day of , 20________, personally appeared
before me, a Notary Public,______________________________________________________________________,
personally known to me to be the person(s) whose name(s) is/are subscribed to the above instrument
who acknowledged that he executed the instrument.
______________________________________
Notary Public Signature
Notary Stamp
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