State of California )
County of __________________ ) ss
On _______________(Date). Before me,________________________(Name and Title of
Officer),personally appeared ____________________________________________(Name of
subscribing witness),proved to me to be the person whose name is subscribed to the
within instrument, as a witness thereto, on the oath of
________________________________________(Name of credible witness,a credible witness
who is known to me and provided a satisfactory identifying document.
________________________________________(Name of subscribing witness),being by me duly
sworn, said that he/she was present and saw/heard
____________________________________________________ (names] of principals]),
the same person(s) described in and whose name(s) is/are subscribed to the
within or attached instrument in his/her/their authorized capacity(ies) as
(a) Party(ies) thereto, execute or acknowledge executing the same, and
that said affiant subscribed his/her name to the within or attached
instrument as a witness at the request of ___________________________________
(Name[s] of principal[s]).
(Notary public seal)
WITNESS my hand and official seal.