Done this | ____________ | day of | _________________ | 20 | ___ | in | _____________. |
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SUBSCRIBED AND SWORN to before me this __________ day of __________ 200 __ in ___________________ affiant exhibited to me this CTC No. ___________________ issued on _________________________ at ________________________________.
Notary Public:
Doc. No. _________________:
Page No ._________________:
Book No. _________________:
Series of 20__