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AFFIDAVIT OF NOTARY PRESENTMENT

CERTIFICATION OF MAILING

State of _____________________________ )
) ss.
County of ___________________________ )

On this _________day of ___________________________, 20______, for the purpose of verification, I, the

undersigned Notary Public, being commissioned in the County and State noted above, do
certify that John Lee Doe appeared before me with the following documents listed below. I,
the undersigned notary, personally verified that these documents were placed in an
envelope and sealed by me. They were sent by United States Post Office Registered Mail
receipt number REGISTERED MAIL # to:

NAME AND ADDRESS OF THE RECEIVER.

Number of Pages

1. NOTARY PRESENTMENT 1
2. Document Enclosed x
3. Document Enclosed x

WITNESS my hand and official seal.

___________________________________ ________________ (Seal)

NOTARY PUBLIC DATE

My commission expires: _________________________, 20_______