Jurat for Joint Affiants)

SUBSCRIBED AND SWORN to before me, this _____________, by _____________ who

exhibited to me (his/her) Community Tax Certificate No. _____________ issued at
_____________ on _____________ and by _____________ who exhibited to me (his/her)
Community Tax Certificate No. _____________ issued at _____________ on _____________.

Notary Public

Doc. No. ______;

Page No. ______;

Book No. ______;

Series of ______;