STATE OF _______________________________
(PARISH)(COUNTY) OF ___________________
BEFORE ME, the undersigned, a Notary Public in and for the aforesaid State and (County)
(Parish), this day personally appeared _________________________, to me personally
known to be the identical person whose name is subscribed to the foregoing Agreement, and
acknowledged to me in the presence of ________________________ and
_______________________, competent witnesses, that [he][she] executed the same on the
date hereof and that it was executed for the uses, purposes and considerations therein
expressed and that [he][she] executed said instrument of [his][her] own free will and accord.
THUS DONE AND PASSED on the day and date above, above given before the
undersigned competent witnesses and me, Notary, after a reading of the whole.
_________________________________________
Borrower
________________________________
___________________________________
Witness: Witness:
Print Name: Print Name:
SWORN TO AND SUBSCRIBED before me, Notary, on the date listed at the top
of this document.
_________________________________
Notary Public (# )
My Commission Expires: _____________