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Acknowledgment by Guardian
STATE OF ----------)
COUNTY OF ---------)
On this [date] before me personally came [name], to me known and
known to me to be the guardian (ad litem) of [name], an infant, and to
be the individual described in and who executed the foregoing instrument
as such guardian (ad litem), and she duly acknowledged to me that she
executed the same as the act and deed of such infant and as such
guardian (ad litem) and for the uses and purposes mentioned therein.
Witness my hand and official seal.
My commission expires: _____