THE STATE OF.............

....................COUNTY.

ss.:

BE IT REMEMBERED, that on this.....day of.......A. D. 19.. before me, the subscriber, a .......... in and for said county, personally came the above named person ............ the Grantor in the foregoing deed, and acknowledged the signing of the same to be ........ voluntary act and deed for the uses and purposes therein mentioned.

IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed my official seal on the day and year last aforesaid.

............................................

Notary Public