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GENERAL36905
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GENERAL36905
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Entry Properties
Last modified
8/24/2016 7:57:15 PM
Creation date
11/23/2007 8:55:15 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981019
IBM Index Class Name
General Documents
Doc Date
5/26/2004
Doc Name
Certificate of Liability Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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CALIFORNIA ALL•PURPOSE ACKNOWLEDGMENT <br />State of California <br />County of l ~-s <br />On <br />personally appeared <br />R <br />Name dntl Tfle of Otlicer (e.g.,'Jane Dce, Notary Publc") <br />/ N~am](s) of Signegs) <br />Lid personally known to me <br />[7 proved to me on the basis of satisfactory <br />evidence <br />to be the persoy(5f whose name,{s~s/~ <br />R.IMILH subscribed to the within instrument and <br />EyFICKI4 acknowledged to me tha she/ executed <br />CommleefonitS~~ £ the same s/her/ r authorized <br />Notary Fubtw- G1Morn capacitand that by s/her/ r <br />Loa M9e~a CourdY <br />~,wt~1,200ff signature on the instrument the perso or <br />MyCgnrn.Fi~ the entity upon behalf of which the persor~ <br />acted, executed the instrument. <br />WI~S m/y hand and official seal. <br />Signature of Notary Public <br />OPTIONAL <br />Though Me inlormafion below is not required by law, it mayprove valuable to persons relying ort the document and crowd prevent <br />fraudulent removal and reattachment o/this form to another document. <br />Description of Attached Document <br />/ /~ <br />Title or Type of Document: ~[G/ /~J/Ll }"/~7'W a~f~~1 lJr~-KGri.° <br />Document Date: t ~/ ~~ /~ 7 Number of Pages: <br />Signer(s) Other Than N/amed Above: <br />Capacity(ies) Claimed by Signer <br />Signer's Name: <br />Individual roP onnumn Hare <br />^ Corporate Officer -Title(s): <br />^ Partner - ^ Limitetl O General <br />^ Attorney-in-Fact <br />^ Trustee <br />^ Guardian or Conservator <br />^ Other: ' <br />Signer Is Representing: <br />ss. <br />before me, <br />O 1999 Nafional NONry As¢ociagon • 9350 Da Soto Ave.. P.O. Bor 2402 • CNatsvroM. CA 91313-2602 • wWw.nafianahroWry org Prod. No. 590] Reomer: Call Toll-Free 1-B00-B]6-602] <br />
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