35 Ill. Adm. Code 807.APPENDIX A
A Financial Assurance Forms
Section 807.APPENDIX AÂ Â
Financial Assurance Forms
Section 807.ILLUSTRATION BÂ Â Certificate
of Acknowledgement
Certificate of Acknowledgement
State of
)
) SS
County of
)
On this
day of
,
before me personally
came
(operator)
to me known, who, being by me duly sworn, did depose
and say
that she/he resides at
(address),
that she/he is
(title)
of
(corporation),
the
corporation
described in and which executed the above instrument; that she/he knows the
seal of
said
corporation; that the seal affixed to such instrument is such corporate seal;
that it was so
affixed by
order of the Board of Directors of said corporation, and that she/he signed
her/his
name
thereto by like order.
Notary Public
My Commission Expires