1
CT Acknowledgment (Corporation) 1 
STATE OF
)SS:
COUNTY OF ___________ )
The foregoing instrument was acknowledged before me this ___day of __________, 20__,
by ___(name with title)____________________ of ____(name of corporation)__________, a
____(state or place of incorporation)__________corporation, on behalf of the corporation.
__________________________________
Notary Public/ Commissioner of Superior Court
My Commission Expires:
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