Copy and Mailing Certification

I, , do certify that ___________________________

appeared before me with the following document(s) listed below. I, the below signed notary, personally
verified the document(s) are a reproduction and is a true, correct and complete copy of the original
document, placed in an envelope and sealed by me, were sent United States of America Post Office by
Registered or Certified Mail as indicated.

This certifies a ______ page document dealing with/entitled ______________________ signed on

______________, and a ______ page document dealing with/entitled______________________
signed on ______________, was sealed and sent by me on the ______ day of _______________ in
the year of 20_____ via  Registered or  Certified Mail # _______________________________ to:

Name
Department
City, State
U.S.A.

____________________________________________ __________________________
Signature of Affiant Date

State of ___________________
County of

Signed and sworn to (or affirmed) before me on

Date

by ,
Printed name of man or woman making statement

who is

personally
known or
proved to me on the basis of satisfactory evidence to be the person

who appeared before me.

(signature of notary public)

Notary Public Stamp/Seal

My commission expires: