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The Affiant, being duly sworn, hereby declares as follows:
STATE OF PENNSYLVANIA
COUNTY OF ________________)
On this __ day of ______, 20__, before me personally appeared ________________, and known or proved by identification to me to be the person described in and who executed the foregoing instrument and having sworn to the above stated facts, acknowledged that he/she executed the same (in his/her authorized capacity) as his/her free act and deed.
My Commission Expires on:
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