$"$On $\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_,$ before me$,$ the undersigned Notary Public in and for said State and County, personally appeared Cindy Signer, who is personally known to me $($or proved on the basis of satisfactory evidence$)$ to be the person$($s$)$ whose name$($s$)$ is$/$are subscribed to within the foregoing instrument and acknowledged to me that he$/$she$/$they executed the same in his$/$her$/$their authorized capacity$($ies$)."$