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HomeMy WebLinkAbout10-0528KWULSI ED BY AND WHEN RECORDED, MAIL TO: CITY ENGINEER CITY OF BAKERSFIELD 1501 TRUXTUN AVENUE BAKERSFIELD, CA. 93301 Own- CERTIFICATE OF MERGER (SECTION 66499.203/4., GOVERNMENT CODE) PARCEL MERGER NO. 10 -0528 Being a merger and re- division of those portions of land shown as Parcels "A ", "B", "C" & "D" of Parcel Merger 08 -0846 as evidenced by that certain Certificate of Merger recorded October 7, 2008 as Document No. 0209147742, also being a portion of the East half of Section 30, T.29S., R.28E., M.D.M. in the City of Bakersfield, County of Kern, State of California. Assessor's Parcel Number: 006 - 092 -16, 006 - 092 -17, 006 - 092 -18, 006 - 092 -19, 006 - 092 -20, 006 -092 -21, 006 - 092 -221 006 - 092 -23, 006 - 092 -24, 006 - 092 -25, 006 - 092 -26, 006- 092 -27, 006 - 092 -28, 006 - 092 -29, 006 - 092 -30, 066 - 092 -31 Property Owners: Michael Craig Wong, an individual; Gordon Cary Wong, an individual; Gregory Steven Wong, an individual.. Cindy L. Wang, a single woman & Steven K. Lee, a joint sin g le man, as tenants; Russell Fred Barnes & Lelia Barnes, trustees of the RB & LB Family Trust dated 3 -30 -1994 as amended 10 -03; - Steven Shu -Yvan Lee & Allie Ho Lee, trustees of the Lee Famil y trust dated 11 -22 -1995; Thomas C. Lester & Sharon L. Lester, husband & wife as community property; Anne E. Lohr, as successor trustee of the Lohr Family Trust It; The Summer Gardens, LLC, a California Limited Liability Company; Nicolaos Perdikaris, an individual; Thomas C.- Chester & Sharon L. Lester, husband & wife; Audrey E. Wheeler & William R. Forney as administers to the estate of Jeff Forney; Lawrence G. Edgar, an individual; BMK Development, LLC, a California limited liability company; This Certificate of Merger is being issued and recorded for 3 Parcel. At the request of the property owner and in accordance with Bakersfield Municipal Code Chapter 16.38, the undersigned City Engineer of the City of Bakersfield, acting herein on behalf of the City of Bakersfield, states that those portions of land described above are hereby deemed merged in accordance with provisions of the Subdivision Map Act of the State of California and Chapter 16 of the City of Bakersfield Municipal Page 1 of 12 SALand DivisionWinor Land Div \mergers\2010 \10 -0528 com.doc Code. The resulting merged parcel is described on the attached Exhibit "A" and shown on the attached Exhibit "B" and associated Exhibit "C ". This certificate relates only o Y issues of compliance or noncompliance with the Subdivision Map Act and local ordinances enacted pursuant thereto. The parcel described herein may be sold, Y leased, or financed without further compliance with the Subdivision Map Act or any may require local ordinance enacted pursuant thereto. Development of the parcel i Y a issuance of a permit or permits, or other grant or grants of approval. Dated: March 7, 201 1 RAUL M. ROJAS RCE No. C -39880 Expiration December 31, 2011 City Engineer City of Bakersfield SIGNATURE MUST BE NOTARIZED Page 2 of 12 S:1Land DivisionWinor Land Divlmergers12010\10 -0528 com.doc %PALIFORNIA ALLoPURPOSE ACKNOWLEDGMENT ':� •' :awn, +'�• %J��'' ;✓''.' i�.'�r'`",•i'^ .. „s' {. "4. ! ". ` .:"'.:. �=i.: .'�.`'` 'ti ,ry:;., ,!� r ,n ..__'..,''•�.. ;; ot:.__ - +_.e_:./..._�._+....:�'7.,. � , �. `, /. ✓ +ftt :.ti.`� �. �t•.c ..,., ♦r ..' %. :�•nri' .'r� -^ r.'.• C^ :,...'y ':�.�'r s•y �'.; :'•' 1':�> � . d. 'J''r :._...r+\. •%• ^.�" ..!� ?+t '. r. - _ .. �, a.... r.... 7+ �'...:. �_. s..: �__.,. .,..:.,r._..___+_r.,.._w...._.. .< .. / .✓i;....�.r f ,•�.. .dam' :,�-�` rc.•..�: •.r<: ;l..r� •_•r'.S''. fit• ,.�t; 'o'."V`. ,i!";o' ?.- ,,.,�� ;F_. ,�:t•'h''�•.. ' `ti. ,w. _ .. _ ....._.._ Y. ti.,..: t. � ..:... ......:...............�•_ ..._...,.....��� �. � . •.f; J.. 4a;?,, � !�'� �'fo�'rS•.. ,,. r', a r•± � �;'. ..� _,;�,,..;,''. '''".`� 1 t i" -y., °. '4 �.,`t�:� State of California County: of RM On ARMst 23 , 2011 before me, Lyn Skinner, ' Notary Public Date Here Insert Name and Tale of the Officer ' personally appeared _ Raul M Ro - as Public Works Director lame(s) of Signer(s) City of Bakersfield ��� -ConaMa=bn t 1825202 Nottty PubNC - CeiNotnia Kern County -► My Comm. Ex fires Doc 4, 2012 who proved to me on the basis of satisfactory evidence to be the person(#] whose name(} is/am subscribed to the within instrument and acknowledged to me that he/sheAbey executed the same in hi 'r authorized capacity), and that by hi signature(jo on the instrument the person(j), or the entity upon behalf of which the person(40 acted, executed the instrument. I certify under PENALTY OF PERJURY under the laves of the State of California that the foregoing paragraph is true and correct. WITNESS n nd and fficial seal. Place Notary Seal Above Signature Signature of Notary Public OPTIONAL Though the infib) ation below is not required by law, it may prove valuable to persons relying on the document and coul event fraudulent removal and reattachment' of this form to another document. Description of Attachedcurnent Title or Type of Document: Document Date: Signer(s). Other Than Tamed Above: Capac'sty(ies) Claimed by Signer(s) Signer's Dame: ❑ Individual ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee Top of thumb here ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Number of Pages: Signer's ame:_ Ej Individua ❑ Corporate O ' E 1:1 Partner — ❑ Lir ❑ Attorney in Fact r Title(s): i'hed ❑ General ❑ Trustee IN ❑ Guardian or Conservator ❑ Other: Signer Is Representing: <`:- ....r.......,.,....- _mow.,....._,. . J .., .. : r.. .'•...✓ :'. ./v7 ,`kw .i•j`:��. %.�;.L..!': ::'4... .,,'n;- ' ✓ter ..... . r\ .. vF V'''i't' � k ©2007 National Notary Association o 9350 De Soto Ave., P.O. Box 2402 Chatsworth, CA 91313 -2402 o vvvvw.NationalNotary.org Item #5907 Reorder: Call Toll -Free 1 -800- 876 -6827 EXHIBIT "A" PARCEL MERGER No. 10 -0528 BEING A MERGER AND REDIVISION OF PARCELS A, B, C. AND D OF PARCEL MERGER No. 08 -0846 PER THAT CERTAIN CERTIFICATE OF MERGER RECORDED OCTOBER 7, 2009 AS DOCUMENT No. 0209147742 OF OFFICIAL RECORDS IN THE OFFICE OF THE KERN COUNTY RECORDER. ALSO, BEING A PORTION OF THE EAST HALF OF SECTION 30, TOWNSHIP 29 SOUTH, RANGE 28 EAST, MOUNT DIABLO. MERIDIAN, IN THE CITY OF BAKERSFIELD, COUNTY OF KERN, STATE OF CALIFORNIA, MORE PARTICULARLY DESCRIBED AS FOLLOWS; PARCEL I BEGINNING AT THE SOUTHWEST CORNER OF PARCEL B OF SAID PARCEL MERGER No. 08 -0846; THENCE ALONG THE BOUNDARY LINES OF SAID PARCEL B THE FOLLOWING NINE (9) COURSES; (1) THENCE NORTH 00 000' 11" WEST, A DISTANCE OF 41.25 FEET; (2) THENCE NORTH 26 028' 19" EAST, A DISTANCE OF 147.57 FEET: (3) THENCE SOUTH 89 059'55" WEST, A DISTANCE OF 2.62 FEET; (4) THENCE NORTH 2205032419 EAST, A DISTANCE OF 53.07 FEET; (5) THENCE SOUTH 89059907" EAST, A DISTANCE OF 4.00 FEET; (6) THENCE NORTH 2200595299 EAST, A DISTANCE OF 52.00 FEET; (7) THENCE NORTH 00 000'24" EAST, A DISTANCE OF 35.01 FEET TO A POINT ON THE SOUTH RIGHT -OF -WAY LINE OF 19" STREET; (8) .THENCE NORTH 00 000'00" EAST, A DISTANCE OF 41.25 FEET TO A POINT ON THE CENTERLINE OF SAID 19th STREET; (9) THENCE ALONG SAID CENTERLINE NORTH 90000'00" EAST, A DISTANCE OF 61.64 FEET; (10) THENCE SOUTH 00000900"' WEST, A DISTANCE OF 41.25 FEET TO A POINT OF SAID SOUTH RIGHT -OF -WAY LINE; (11) THENCE SOUTH 23 000'01" WEST, A DISTANCE OF 231.18 FEET; (l 2) THENCE NORTH 900009009') WEST, A DISTANCE OF 0.55 FEET; (13) THENCE SOUTH 22 055' 26" WEST, A DISTANCE OF 38.41 FEET; (14) THENCE SOUTH 00000911" EAST, A DISTANCE OF 57.26 FEET TO A POINT ON THE CENTERLINE OF 18th STREET; Sheet " of �7 Sheets (15) THENCE ALONG SAID CENTERLINE SOUTH 89 059949" WEST, A DISTANCE OF 63.12 FEET TO THE POINT OF BEGINNING. CONTAINS: GROSS AREA = 18,606 SQUARE FEET MORE OR LESS. NET AREA = 13,459 SQUARE FEET MORE OR LESS. PARCEL 2 BEGINNING AT THE SOUTHEAST CORNER OF PARCEL "A" OF SAID PARCEL MERGER No. 08 -0846, SAID POINT BEING ON THE CENTERLINE OF 18th STREET; (1) THENCE ALONG SAID CENTERLINE SOUTH 89 059'49" WEST, A DISTANCE OF 232.17 FEET; (2) THENCE NORTH 00 °00' 11" WEST, A DISTANCE OF 57.26 FEET; (3) THENCE NORTH 22 055926" EAST, A DISTANCE OF 38.41 FEET; (4) THENCE SOUTH 90 000'00" EAST, A DISTANCE OF 0.55 FEET; (5) THENCE NORTH 23 000901" EAST, A DISTANCE OF 231.18 FEET TO A POINT ON THE SOUTH RIGHT -OF -WAY LINE OF 19th STREET; (6) THENCE NORTH 00000'0099 EAST, A DISTANCE OF 41.25 FEET TO A POINT ON THE CENTERLINE OF SAID 19th STREET; (7) THENCE ALONG SAID CENTERLINE NORTH 90000900'9 EAST, A DISTANCE OF 149.92 FEET; (8) THENCE SOUTH 00 000'00" WEST, A DISTANCE OF 41.25 FEET TO A POINT ON SAID. SOUTH RIGHT -OF -WAY LINE; (9) THENCE SOUTH 23 000900" WEST, A DISTANCE OF 84.32 FEET; (10) THENCE SOUTH 90 000'00" EAST, A DISTANCE OF 72.12 FEET; (11) THENCE SOUTH 00 000900" WEST, A DISTANCE OF 54.47 FEET; (12) THENCE SOUTH 89 05955" WEST, A DISTANCE OF 14.41 FEET; (13) THENCE SOUTH 2205692519 WEST, A DISTANCE OF 124.08 FEET; (14) THENCE SOUTH 000009119" EAST, A DISTANCE OF 59.07 FEET TO THE POINT OF BEGINNING. CONTAINS: GROSS AREA= 70,652 SQUARE FEET MORE OR LESS NET AREA = 53,242 SQUARE FEET Sheet 5 of i� Sheets PARCEL 3 BEGINNING AT THE NORTHEAST CORNER OF PARCEL D OF SAID PARCEL MERGER No. 08 -0846; THENCE ALONG THE BOUNDARY LINES OF SAID PARCEL D THE FOLLOWING TWO (2) COURSES; (1) THENCE SOUTH 00 000'00" EAST, A DISTANCE OF 173.33 FEET; (2) THENCE SOUTH 89059'55" WEST, A DISTANCE OF 30.50 FEET; (3) THENCE NORTH 00 000900" EAST, A DISTANCE OF 54.47 FEET; (4) THENCE NORTH 90000'00" WEST, A DISTANCE OF 72.12 FEET; (5) THENCE NORTH 23 000'00" EAST, A DISTANCE OF 84.32 FEET TO A POINT ON THE SOUTH RIGHT -OF -WAY LINE OF 19th STREET; (6) THENCE NORTH 00 000'00" EAST, A DISTANCE OF 41.25 FEET TO THE CENTERLINE OF SAID 19th STREET; (7) THENCE ALONG SAID CENTERLINE NORTH 90000'00" EAST, A DISTANCE OF 69.68 FEET TO THE POINT OF BEGINNING. CONTAINS: GROSS AREA =11,222 SQUARE FEET MORE OR LESS. NET AREA =89043 SQUARE FEET MORE ORT LESS. QjkL10FEss10 ,�i y�I;n w. p,�r�� F� C.5 rte.► * RCE 33448 CIVI OF CALIF Sheet 6— ofl!,�.-- Sheets Date BEING A MERGER AND REDI ISION OF PARCELS A. B, C. AND D OF PARCEL MERGER No. 08 -0846 PER THAT CERTAIN CERTIFICATE OF MERGER RECORDED OCTOBER 7, 2009 AS DOCUMENT No. 0209147742 OF OFFICUAL RECORDS IN THE OFFICE OF THE KERN COUNTY RECORDER, ALSO, BEING A PORTION OF THE EAST HALF OF SECTION 30, TOWNSHIP 29 SOUTH, RANGE 28 EAST, MOUNT DIABLO MERIDIAN, IN THE CITY OF BAKERSFIELD COUNTY OF KERN STATE OF CAUFORNUL BASIS OF BEARINGS: v ' ALL BEARINGS AND DISTANCES SHOWN UPON THIS ILLUSTRATION ARE MEASUREMENTS OF RECORD OR CALCULATED FROM RECORD PER THE RECORD OF SURVEY FILED IN BOOK 25 OF RECORD OF SURVEYS AT PAGE 15 IN THE OFFICE OF THE KERN COUNTY RECORDER. PREPARED BY: PORTER AND ASSOCIATES, INC. 1200 21st STREET "THIS MAP IS PROVIDED FOR ILLUSTRATIVE PURPOSES ONLY" BAKERSFIELD, CALIFORNIA 93301 (661) 327 -0362 PROPERTY OWNERS: 1. MICHAEL CRAIG WONG, AN INDIVIDUAL FWD W. PORTER DATE 2. GORDON CARY WONG, AN INDIVIDUAL 3. GREGORY STEVEN WONG, AN INDIVIDUAL 4. BMK DEVELOPMENT, LLC, A CALIFORNIA LIMITED LIABILITY COMPANY 5. RB & LB FAMILY TRUST DATED 3 -30 -1994 AS AMENDED 10 -03 6. STEVEN SHU —YUAN LEE AND ALLIE HO LEE REVOCABLE TRUST DATED 11 -22 -1995 7. THOMAS C. AND SHARON L. LESTER, HUSBAND AND WIFE 8. THE LOHR FAMILY TRUST II 9. THE SUMMER GARDENS, LLC, A CALIFORNIA LIMITED LIABILITY COMPANY 10. NICOLAOS PERDIKARIS, AN INDIVIDUAL 11. CINDY L. WANG AND STEVEN K. LEE, AS JOINT TENANTS 12. JEFF FORNEY, AN INDIVIDUAL 13. LAWRENCE G. EDGAR, AN INDIVIDUAL /QROFESS /ONq� W. PpRT�op FyGi w m * RCE 33448 \1 V 1 F OF CA��F�/ EASEMENT TABLE: (I> AN EASEMENT IN FAVOR OF CITY OF BAKERSFIELD FOR SEWER, STORMDRAIN, AND PUBLIC UTILITY PURPOSES PER DOCUMENT RECORDED APRIL 23, 1947 IN BOOK 1341 AT PAGE 246 OF OFFICIAL RECORDS IN THE OFFICE OF THE KERN COUNTY RECORDER AN EASEMENT IN FAVOR OF UNDERGROUND COMMUNICATIONS FACILITY PURPOSES PER DOCUMENT RECORDED MAY 20, 2009 AS DOCUMENT No. 0209073591 OF OFFICIAL RECORDS IN THE OFFICE OF THE KERN COUNTY RECORDER LEGEND:; —:—_, i� y�s�.� �.._.... __ I i L 0 2" IRON PIPE OR PENNY TAG IN CONCRETE STAMPED TAGGED "RCE 33448" PER RECORD OF SURVEY FILED IN RS BK 25, PG 15 STATISTICS: A.P.N. WATER: POWER: GAS: SEWER: TELEPHONE: CABLE TV: EXISTING ZONING: PROPOSED ZONING: EXISTING LAND USE: PROPOSED LAND USE: G.P. 006- 092 -16, 17, 18, 19, 20, 21, 22 006 - 092 -239 249 251 261 271 28 006 - 092 -29, 301 31 CITY OF BAKERSFIELD PACIFIC GAS & ELECTRIC COMPANY PACIFIC GAS & ELECTRIC COMPANY CITY OF BAKERSFIELD AT &T BRIGHTHOUSE NETWORKS CC CC VACANT /COMMERCIAL COMMERCIAL /MULTI FAMILY RESIDENTIAL MCU AQINITY MAP NOT TO SCALE - i - SHEET DATE 05/18/2011 PA JOB No. 08 -2266 EXHIBIT B -7 r PORTER & ASSOCIATES INC. PARCEL MERGER No. 10-0528 ENGINEERING & SURVEYING TITLE, S 1200 21st Street, Bakersfield, California 93301 OF [Z SHEETS 661.327.0362 FAX 661.327.1065 FESS/ W. i'd rn RCE 33448 FRED"W. PORTER DATE %P ,O;x /W OF C A&. N SCALE: 1*= 10' 0 2.5 5 10 N 90"00'00" W 0. 55' 4,V 5\v -Z �/ DETAIL SHEET c 9; DATE 05/18/2011 PA JOB No. 08-22661 LINE TABLE PORTER & AS . SOCIATES, INC. p ENGINEERING & SURVEYING LINE BEARING 1200 21 st Street, Bakersfield, Califomia 93301 661.327.0362 FAX 661.327.1065 LENGTH Ll N 89*5955" E 30.50 L2 N 89*59*55" E 14.41' L3 N 89*59'55" E 40.47 L4 N 89059'55"' E 44.91 L5 N 89'059'55" E 2.62 L6 N 22*50124"' E 53.07 v L7 N 89*59"07p' W 4.00" L8 N 22*05'52" E 52.00 1 L9 N 00'600'24" E 35.01' L10 N 001100000"' E 41.25 L11 N 00*00'1 Vp W 41.25 1 Ll 2 N 89'059'55" E 14.41 Ll 3 N 89*5955" E 30-50' 114 N 00*00'00" W 54.47 1 Ll 5 S 00'000111 " E 59.07' 116 N 90"00'00p* W 0.55 1 Ll 7 N 22055'2611 E 38.41' L18 IN 00*00'11 W 1 57.26 SHEET c 9; DATE 05/18/2011 PA JOB No. 08-22661 EXHIBIT B PARCEL MERGER No. 10-0528 PORTER & AS . SOCIATES, INC. p ENGINEERING & SURVEYING A 03 OF I, �- SHEETS DATA AND DETAIL SHEET 1200 21 st Street, Bakersfield, Califomia 93301 661.327.0362 FAX 661.327.1065 of E ss EXHIBIT "B" Q� ON,q W-�� o w• Po "THIS MAP IS PROVIDED FOR ILLUSTRATIVE PURPOSES ONLY RCE 33448 FRED PORTER DATE ,* F or CA 19th STREET N 9o•oo'00" E 281.23' -T 0 66.53' 0 139.77' 0 74.93' �o i w 11 , 889 SQ FT W � o W w (GR) o I � v i <v� �°" 81493 SQ FT o 0 V) �- CO * o o (NET) o o .��.. ,d` ^ ,� ,�'? N 90.00' 00 "W N o I o� ,��. _ D L7 .� co 329812 SQ FT (GR) c�, r�, -:� 78.47 � cn ft 27 046 SQ FT NET �, B 0 � L12 J L1 0 5 Iry o N &A 0 Ay! N O w L4 h h T �0• w ww ww � .` f f> > �. I V �J ; S 90.00 0o W 139.77 ^ •�--, I w �v 3: IN 9 I f V I Aj- `v 36,407 SQ FT (GR) A 20 Z ow ^• 24, 970 SQ FT (NET) � �EXISTINGL .i 16 0' BUILDING _ SIDEWALK r LO -1-58.01 237.28' N 89 °59'49" E 295.29' 1 LEGEND SCALE: 60' - N A PARCEL DESIGNATION 0 15 30 60' SHEET DATE 05/18/2011 IPA JOB No. 08 -2266 EXHIBIT B ID PORTER & ASSOCIATES INC. PARCEL MERGER N o ■ 1 0-0528 r ENGINEERING & SURVEYING AS EXISTING 1200 21st Street, Bakersfield, California 93301 OF P SHEETS 661.327.0362 FAX 661.327.1065 QROfESS /p EXHIBIT ABA ,`�� �o W•POR �F "THIS MAP IS PROVIDED FOR ILLUSTRATIVE PURPOSES ONLY cz La rn °' /I * RCE 33448 * FRED PORTER DATE OF CA��F SHEET 19th STREET N 9o•o0'00" E 281.23' 61.6 4' 149.9 2' �'r 69.68 ' 0 1 0 0 0 W J C O 2 .. W 00 n 0 W T 00 `y 11,222 S.F. GR w o ' ��•Q. � �' 89043 S. F. NET.- � 0 C� L c ! 0 N V) co 72-12 w� 0 ,C!+� �v S 90'00'00" E o O _L 0 Z N - o L2 Ll /• r� Cb h � I 70,652 SQUARE FEET GROSS Q 53,242 SQUARE FEET NET "� I �� '� ! SEE DETAIL ON OTHER SHEET `---i C\V �Q 16 (EXISTINGL b o' BUILDING w J J 63.12 �•- ro OF I*-- 232.17' N 89.59'49" E 295.29' LEGEND ( 1 )PARCEL DESIGNATION DATE 05/18/2011 PA JOB No. 08 -2266 LO r- � 18th STREET SCALE: so -N- 0 15" 3V 60' EXHIBIT B PARCEL MERGER No. 10 -0528 AS MERGED AND REDIVIDED r PORTER & ASSOCIATES INC. ENGINEERING S SURVEYING 1200 21 st Street, Bakersfield, Califomia 93301 661.327.0362 FAX 661.327.1065 EXHIBIT C DEED OF TRUST CONSENT The undersigned, claiming- some right, title or interest in and to the above described real property, consent to making of the foregoing Parcel Merger No. 10 -0529 and agree to be bound thereby and agree that their right, title or interest is subject to such Parcel Merger. BAKERSFIELD REDEVELOPMENT AGENCY, a public body, corporate and politic; as beneficiary, per Deed of Trust recorded December 12, 2008 as Document No. 0208192879 of Official Records in the office of the Kern County Recorder. Signature Date Donna L. Kunz Economic Development Director / / C. P; /Z State of California County of --�'' CIVIL CODE § 1189 before me, IX.0 C6, 0 1 (i � iL,,L , Date Here Insert Name and Title of the Officer personally appeared C fg � kL � N Y NN Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person whose name is /afs-- subscribed to the within ins rument and acknowledged to me that 4/she /they executed the - same in /her /t;& authorized capacity and that by DEBBIE L. SCANLAN h46 /her / signature(4 on the instrument the Cornrmssion # 1919305 person(W or the entity upon behalf of which the a ,Via' Notary Public - California personM acted, executed the instrument. Z Y Kern Count. y �. My Comm. Expires Jan 24, 2015 I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature ' Place Notary Seal Above Signature of Notary Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the and could prevent fraudulent removal and reattachment of this form to another Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Individual O Partner — O Limited ❑ Gen( • Attorney in Fact • Trustee • Guardian or Conse or ❑Other: , Signer Is Representing: Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): IGHT THUMBPRINT ❑ Individual - OF SIGNER ❑ Partner — ❑ Limited ❑ General Top of thumb here ❑ Attorney in -Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: © 2010 National Notary Association o NationalNotary.org o 1- 800 -US NOTARY (1- 800 - 876 -6827) 12, Item #5907 �2 of