State/Republic of _____________
County/City of _______________
SUBSCRIBED AND SWORN TO BEFORE ME, a NOTARY PUBLIC from (County/City), (State/Country), this (Date) day of (Month), (Year); personally appeared bearing the government identification with details provided below, to wit;
Name ID Type/Number Date/Place of Issuance
[Employer.FirstName][Employer.LastName] (Employer ID) (details)
[Executive.FirstName][Executive.LastName] (Executive ID) (details)
Known to me and known to be the same parties who executed the foregoing instrument consisting of five (5) pages, including the page where this acknowledgment is written, and they acknowledged that the same is their own free and voluntary act and deed and that of the corporations represented.
IN WITNESS WHEREOF, I have hereunto set my hand and the notarial seal on the date and in the place herein above written.