Ill. Admin. Code tit. 14 , J, Appendix A, ILLUSTRATION F
Current through Register Vol. 48, No. 25, June 21, 2024
STATE OF | ) | SS |
) | ||
COUNTY OF | ) |
On this _______________ day of __________________, ________, before me ______________ the undersigned officer, personally appeared ______________ to me personally known and known to be the same person(s) whose name(s) is (are) signed to the foregoing instrument, and acknowledged the execution thereof for the uses and purposes therein set forth.
IN WITNESS WHEREOF I have hereunto set my hand and official seal.
_______________________________
Notary Public
(Notarial Seal)
My commission expires: _______________
Ill. Admin. Code tit. 14 , J, Appendix A, ILLUSTRATION F