PLACE COPY OF STATE ISSUE ID HERE by qob12941

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									                                    PLACE COPY OF

                                     STATE ISSUE ID

                                          HERE




The above is a true copy of my State Issue Identification and I am requesting Notary Central

Supplies to create a pre-inked stamp of my signature. Signature is to be created as shown in this

example: (Place signature in open space below and also sign on the signature line)

                                                     Place signature for stamp in open area below




_________________________________
            Signature



State of : ___________________________

County of: ____________________________

Sworn and subscribed before me, _______________________________this __________

day of __________, __________ by __________________________________________.


___________________________________
          Notary Public

____________________________________
       My commission expires

								
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