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GENERAL51795
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GENERAL51795
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Entry Properties
Last modified
8/24/2016 8:37:54 PM
Creation date
11/23/2007 7:09:49 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981019
IBM Index Class Name
General Documents
Doc Date
7/21/2003
Doc Name
Certificate of Insurance
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT <br />State of California <br />ss. <br />County of /x5 /7/tiQt,! G~.S <br />personally appeared <br />before mE~//l ~d ~. ~ Oi-PLC. IV /~-9.~i.~ ~c~(~{h~, , <br />q Name ana Tille of OMicer ( .,'Jane Doe, Nora Publk'q <br />~tcV W CKq R FiNLE <br />_11111 Cornrnhalorr i <br />Notary Publk - CaGfomia ~ <br />l.os Jingalas CourHy <br />11AyCarrnn. ExpiresJW 21,2008 <br />n~~~a,,,,,m///eist m sgnegs~ <br />personally known to me <br />^ proved to me on the basis of satisfactory <br />evidence <br />to be the person whose name~.s)'is re <br />subscribed to the within i trument and <br />acknowledged to me that h e ey executed <br />the same in hi heir auihor~zed <br />capacitysie'~1,, and that by his .rk air <br />signatur on the instrument the personja)!or <br />the entity upon behalf of which the personfs'~ <br />acted, executed the instrument. <br />WIT SS my hand and official seal. <br />~• <br />Sigiumre otary Public <br />OPTIONAL <br />Though the in/ormation below is not required by law, it may prove valuable to persons relying on the document and could prevent <br />Iraudulent removal and reattachment o/this /omr to another document. <br />Description of Attache/d~ Doc~u pment (' / //, /__ <br />Title or Type of Docu~m(ent:/C.~+Gr'7"N+ -J~ f3f' /~-~LLU~ 1 ~ ~`~ ~F->576~()/~LI/L~~-C <br />Document Date: _ 1 /~L ~ ~ 7 t ,n`~ dd 3 Number of Pages: ,e <br />_Signer(s) Other Than Named Above: ! v Q ~r-c~ _ rt L[_/-S <br />Capacity(ies) Claimed by Signer <br />Signer's Name: ~C-~\ 10.,-• <br />Individual iopamumDnere <br />Corporate Officer - Tille(s): <br />^ Partner-^Limited ^General <br />^ Attorney-in-Fact <br />^ Trustee <br />^ Guardian or Conservator <br />^ Other: <br />Signer Is Representing: u <br />O 1999 National Notary Associslion • 9359 De Sato Ave., P.O. Box 2402 • Cbatswoeb, CA 913132402 • xww.nalanalnoUryorg Prof. No. 59W ReoMec Cell Toll-Free 1-BO0.3]G632] <br />
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