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SAMPLE FORM

ACKNOWLEDGEMENT OF INDIVIDUAL

STATE OF            Colorado¹     )
                                                      )ss
COUNTY OF           Crown²     )

The foregoing instrument was acknowledged before me this 21st day of

July , 2001³, by Ken Mann⁴ ,

who is personally known to me or the identity of whom has been established

by credible witness.

_______________________⁵ Signature

Notary Public⁶
Title

NOTES
The above is an example of how a typical Acknowledgement Of Individual form may be completed.

The state in which the document is acknowledged.
The county in which the document is acknowledged.
The date the document is signed.
The person who executed the document for acknowledgement.
The signature of the person notarizing the document.
The title of the person notarizing the document.

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This is not a substitute for legal advice. An attorney must be consulted.