UNIFORM FORM CERTIFICATE OF ACKNOWLEDGMENT (Within New York State) State of New York ) County of ____________________ ) ss.: On the ____ day of _________ in the year ____ before me, the undersigned, personally appeared __________________________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. __________________________________ (Signature and Office of individual taking acknowledgment) American LegalNet, Inc. www.FormsWorkflow.com