GENERAL45653

• Permit No: C1981019
• IBM Index Class Name: General Documents
• Doc Date: 6/29/2004
• Doc Name: Certificate of Liability Insurance
• Permit Index Doc Type: Insurance
• Media Type: D
• Archive: No

CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
n ss.
County of ~`> F•F r.w~le S
On ,~ul~e ~.~~7 betoreme, ~~21 ~{ ~u~.
Gate -~' /~ Name aM Tnle of OXker (e.g,
personally appeared J O~N hr~ (J • {1~ L 1~
TERRI R. BUCY
Commission { 1343798
Notary Public - Cahfomia ~
~ Los Angebs County
MY Comm. E~ireaFeb 78, 2006
personally known to me
^ proved to me on the basis of satisfactory
evidence
to be the person(a)' whose name(s) is/art'
subscribed to the within instrument and
acknowledged to me th e/ /tFrey executed
the same in hi /her/their authorized
capacity(ies), an that by is /their
signature(s)ron the instrument the person(aYor
the entity upon behalf of which the person(s)
acted, executed the instrument.
WITNESS my hand and official seal.
v Signature of Notary PuN'c
OPTIONAL
Though the inrormation below is naf requiretl by law, it may prove valuable to persons relying on the document and could prevent
/mudulenf removal and reattachment o/this lorm to another document.
Description of Attached Document
Title or Type of Document: ~o rYt~l~ c7"C ~r ~~• ~'tSs TY~surG.nc.~
Document Date: ~~S ~ AA //'' Number of Pages:
Signer(s) Other Than Named Above: ~U OTA~ 5 f 4 new S
Capacity(ies) Claimed by Signer
Signer's Name:
^ IndIVldUal lop of thumb Here
^ Corporate Officer-Title(s):
^ Partner-^Limited ^General
^ Attorney-in-Fact
^ Trustee
^ Guardian or Conservator
^ Other:
Signer Is Representing:
O 1999 Naiionel Notary Assaiei'ron • 9350 De SMO Ave., PO. Bov 2b2 • CbalswoM. CA 9131 3-20 0 2 • wvw.nallonalnoteryarg Pmtl. No. 590] Reartlar: Call Toll-Free tEW-8]6602]