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STATE OF MINNESOTA <br />COUNTY OF HENNEPIN <br />Notary Public <br />On this __ day of ______ , 20_, _____________ _ <br />personally appeared before me, <br />__ who is personally known to me <br />__ whose identity I proved on the basis of ________________ _ <br />whose identity I proved on the oath/affirmation of ____________ _ <br />a credible witness <br />and who executed the foregoing instrument, and acknowledged that he/she/they executed the same <br />as his/her/their free act and deed. <br />Notary Public <br />Page 6 of 8