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20-22569
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2020
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20-22569
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Last modified
5/17/2021 11:27:35 AM
Creation date
5/17/2021 11:27:35 AM
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Building Department
Building Department - Doc Type
Permit
Permit #
20-22569
Building Department - Name
CHRISTIANSON,RUSSELL ANTHONY & AP
Address
38834 5TH AVE
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OR BK 10063 PG 1 088 Page 2 of 2 <br /> CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 <br /> A notary public or other officer completing this certificate verifies only the identity of the individual who signed the <br /> document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. <br /> State of California ) <br /> County of '%?& �.AA ) <br /> On -o?_S" --2 0 before me, �a; <br /> Date Here Inse Name and Tie of the Officer <br /> personally appeared - <br /> Na e(s)of Signers) <br /> who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are <br /> subscribed to the within instrument and acknowledged to me that he/she/they executed the same in <br /> his/her/their authorized capac'ity(ies),and that by his/her/their signature(s)on the instrument the person(s), <br /> or the entity upon behalf of which the person(s)acted, executed the instrument. <br /> I certify under PENALTY OF PERJURY under the laws <br /> of the State of California that the foregoing paragraph <br /> oAY <br /> is true and correct. <br /> MARGE <br /> Notary Public-Callfornfa WITNESS my hand and official seal. <br /> Placer County <br /> Commission N 2260733 <br /> *MY <br /> Comm.Expires Oct 28,2022 <br /> Signature Xm <br /> ,lignatureloNotaryPublk <br /> Place Notary Seal Above <br /> OPTIONAL <br /> Though this section is optional, completing this information can deter alteration of the document or <br /> fraudulent reattachment of this form to an unintended document <br /> Description of Attached Document <br /> Title or Type of Document: Document Date: <br /> Number of Pages: Signers) Other,Than Narned'-Above: <br /> Capacity(ies)Claimed by Signers),. <br /> Signer's Name: Signer's Name: <br /> ❑Corporate Officer — Title(s): ❑Corporate Officer— Title(s): <br /> Partner — ❑:Limited p General..;.,,.:.; ❑Partner — ❑Limited ❑General <br /> ❑ Individual ❑Attomey in Fact.., ; ❑Individual ❑Attorney in Fact <br /> ❑Trustee ;❑,Guardian or Conservator L Trustee ❑Guardian or Conservator <br /> ❑Other: ❑ Other: <br /> Signer Is Representing: Signer Is Representing: <br /> ©2014 National Notary Association -www.NationalNotary.org - 1-800-US NOTARY(1-800-876-6827) Item#5907 <br />
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