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, FORM OF INDIVIDUAL ACKNOWLEDGMENT Proper executiori of`the Individual ficknowleclgment ar.d in-a num.ber of different circumstances. requires that the customer appear before the notary to 2. Satisfactory Evidence - Use this method to authenticate his or her signature on a document, and that identify custoiners you do not know through the notary complete the written form of acknowledg- personal knowledge. You may accept a current ment, confirming the customer's identity and intention government-issued identification card that bears a to sign. photograph, signature or physical description of the bearer and a serial or identification number. If The Individual Acknowledgment allows one or more your customer does not have proper government- individuals to acknowledge signatures, each acting on issued identification, you inay accept the testimony his or her own behalf. of a c��edible witness to identify your customer.A Before administering this acknowledgment, you must credible wifiess is a person personally known to positively identify your customer using one of the you and to your customer who testifies under oath following methods: to the identity of your customer. � 1. Personal Knowledge -Use this inethod if you Fill out the Acknowledgment using the instructions have known your customer for a length of time below and complete your register entry. Instructions for completing the Form of Individual Acknowledgment: 1. Complete the venue.The venue contains the name of the state and county where the notarization is FORM OF INDIVIDUAL ACKNOWLEDGMENT performed. 2. Wnte the date the acknowledgment is taken. The date must be the date the customer appeared before Commonweaith of Pennsylvania you and acknowledged the signature. The date of County ot �1Q�egReku �'�` the document the customer signed may be different. 3. Write your official name and title. on this,the � day of �eCew�ben ,20 05 ,before me '� �Donot� �Doe a Kotan ubQiC ,the undersigned o�cer,personally 4. Write the name and address of your custoiner after ;,_. identifymg the customer according to law. appeared Ja�es aKd Cu�tP,�a JoKes, 123 BP.00w�iu� LaKe, P�ttsbun�R, � 5. If there is more than one customer making an p� ,known to me(or satisfactorily proven)to be the personS whose � " ___ _ __ 3Ckn�w1_edgment,_add_".S'_' to `_`person". Otherwise, nameS_ Qhe-: subscribed-to the w�thin instrumen!, and-acknowledged- ^� - —,--. leave empty. that �he1¢ executed the same for the purposes therein contained 6. If there is more than one customer making an aCltiloWledgment, add"S"t0 "narile" and wrrte In witness whereof, I hereunto set my hand and official seaL I "are" in the next blank. Other.wise,.leave the,space, after"name" empty and write"is":in the next , �� � blank. a . ; ' ,Oe�,�a-� �:�' 7 Write"he","she", or"tl�ey" as appropZi.ate.� , Notary Public 8. Sign your official signature above your title. ��"""""""1°",,,,�„ \\�p�o�pTHy� i�/ COMMONWEAL7H OF PENNSVLVANIA •4 9. Place our official rubber stam seal near our si - �� o� °"'"`�so�'%, NOTARIALSEAL y P y g _ DOROTHY DOE,NOTARY PUBLIC T 1 — ` ov = PLEASANTBORO,ALLEGHENYCOUNTY Il[l�l�f'.. 1 ly ll�t t� �Ver13p y�uI�$lgll$�re�r any = � MY COMMISSION EXPIRES MAY 1,20XX text on the document. �OT��"r�v'`�J yti�� Member,PennsylvanlaAssociationofNotaries ��ii�i//,9/Rll Nn�J�\\\\\\e �� - - 1.0 Impress-your-embossing seal on-the-document r_Par - ---- ---- ---- --- -- -- - - - - -- your signature.Although this�s no longer required PAN-1(12I05) by law you are permitted to use an embossing seal '3'='� ' "' ' ) � P�rno.E1t3B1.0618 Faa:Af1.281-0311•Y1oEsko.rv.w,rwuryorg Erad�pnQorm�nxo.rnm if you desire. T� �-�ord.�r, call �00-9��w�790 or �rd�r or�line �� rw.a�o�ar�.orge Pennsylvania Association of Notaries • Phone: 412-281-0678 • Fax: 412-281-0321 • E-mail: pan@ermunro.com