County of (County)

ss

State of Wyoming,

On this ________ day of ______________________, 20______, _____________________________________________________

_______ who is personally known to me

_______ whose identity I proved on the basis of___________________________________

_______ whose identity I proved on the oath/affirmation of _________________________,

a credible witness duly sworn, personally appeared before me and acknowledged that she executed the same.

Witness my hand and official seal:

_______________________________________

(Your Name)

Notary Public

My Commission Expires: (Date your Commission expires).

County of (County)

ss

State of Wyoming,

The foregoing instrument was acknowledged before me by ______________________________

_____________________________________ this ____________ day of___________________,

20____________.

Witness my hand and official seal:

_________________________________________

(Your Name)

Notary Public

My Commission expires: (Date your Commission expires)

County of (County)

ss

State of Wyoming,

On the ____________ day of ______________________________________, 20____________

_________________________________________whom I know personally appeared before me

and acknowledged that he executed it.

Witness my hand and official seal:

_________________________________________

(Your Name)

Notary Public

My Commission expires: (Date your Commission expires)

County of (County)

ss

State of Wyoming,

On the ____________ day of ______________________________________, 20____________

_________________________________________, whose identity was proven to me on the oath of _______________________________________, a credible witness duly sworn, personally appeared before me and acknowledged that she executed the same.

Witness my hand and official seal:

_________________________________________

(Your Name)

Notary Public

My Commission expires: (Date your Commission expires)

County of (County)

ss

State of Wyoming,

On the ____________ day of ______________________________________, 20____________

_________________________________________, whose identity was proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to this instrument, personally appeared before me and acknowledged that he executed it.

Witness my hand and official seal:

_________________________________________

(Your Name)

Notary Public

My Commission expires: (Date your Commission expires)

County of (County)

ss

State of Wyoming,

On the ____________ day of ______________________________________, 20____________

I swear (or affirm) that the preceding/.attached document is a true copy.

Witness my hand and official seal:

_________________________________________

(Your Name)

Notary Public

My Commission expires: (Date your Commission expires)

DATE	TIME	NAME OF SIGNATOR

IDENTITY VERIFIED

BY:	ADDRESS OF SIGNATOR	COMMENTS