| Name of Person |
| (Signed and Sealed) . . . . |
| Certificate No. . . . . |
AUDITOR'S CERTIFICATE
Filed for record this . . . . day of . . . . . ., (year) . . . . at . . . . .M. in book . . . . of . . . . at page . . . . at the request of . . . . . . . . .
| (Signed) . . . . |
| County Auditor |