EXAMPLE OF WHAT A NOTARY STATEMENT MIGHT LOOK LIKE

“UNIFORM ACKNOWLEDGEMENT”

Dated____________________                 ________________________________

                                                                        ________________________________

                                                                        ________________________________

                                                                                                 (signatures)

STATE OF NEW YORK    )

                                             )         ss.:

COUNTY OF MONROE    )

            On the _______day of ____________in the year____________, before me, the undersigned, personally appeared ______________________________personally known to me or proved to me on the same basis of satisfactory evidence to be the individual(s) whose names(s) is (are) subscribed to the within instrument and acknowledge 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.

________________________________________________

Notary Public, State of New York/Commissioner of Deeds      

Commission Expires:_______________