(Multiple Affiants)

SUBSCRIBED AND SWORN to before me, this _____________, by the following who
are all personally known to me (or whom I have identified through competent evidence of identity)
and who exhibited to me their respective Community Tax Certificates as follows:

Name C.T.C. No. Date / Place Issued

1. _____________ _____________ _____________

2. _____________ _____________ _____________
3. _____________ _____________ _____________

NOTARY PUBLIC

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 20____.