E-831 Dedication in Fee for Roadway Purposes, 21800 Almaden Ave, APN 375-15-035RECORDING REQUESTED BY:
City of Cupertino
WHEN RECORDED, MAIL TO:
City Clerk's Office
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
NO FEE IN ACCORDANCE
WITH GOV. CODE 27381
23521845
Regina Alcomendras
Santa Clara County -Clerk-Recorder
12/07/2016 03:10 PM
Ti lles: 1
Fees: $0 .00
Taxes: $0
Total: $0 .00
Pages: 7
(SPACE ABOVE THIS LINE FOR RECORDER'S USE)
Re-Recordation of Document# 23396330
DEDICATION IN FEE
FOR ROADWAY PURPOSES
In order to Correct APN# 375-15-035 to 357-15-035
21800 Almaden Avenue, Cupertino, CA 95014
APN 357-15-035
'Jzy Original
D For Fast Endorsement
"NO FEE"
City of Cupertino
CERTIFICATE OF ACCEPTANCE is hereby given in order to comply with the
provisions of Section 27381 of the Government Code.
This is to certify that the interest in real property conveyed by the deed or grant
dated November 15, 2016, from
21800 Almaden Avenue, Cupertino, CA 95014
to the City of Cupertino, a governmental agency, is hereby accepted by order of the Public
Works Director, and the grantee consents to recordation thereof by its duly authorized
officer.
Dated: December 7, 2016
w
By: ~Wi &
Lauren Sapudar
Senior Office As sistant
DEDICATION IN FEE
FOR ROADWAY PURPOSES
21800 Almaden A venue, Cupertino CA 95014
APN 357-15-035
Hestia Home LLC, a California limited liability company, dedicates in fee to the CITY OF
CUPERTINO, a California municipal corporation, for public purposes including, but not limited
to roadway purposes, together with the right to construct, repair, operate, and maintain any and
all public utilities and improvements in, on, under, along and across the real property which shall
be or become necessary for preservation of the public safety, welfare or convenience, the real
prope1iy described in Exhibit A and shown in Exhibit B, which is situated in the City of
Cupertino , County of Santa Clara, State of California.
i (~ I IN WITNESS WHEREOF, executed this ---.L..2..-day of / c,HJ , 2016.
City of Cupertino:
~~~-, .. P_E __
Director of Public Works
(Notary acknowledgment to be attached)
Owner:
\
Zhimei Wu
Executive Manager
EXHIBIT "A"
LEGAL DESCRIPTION
ROADWAY DEDICATION
LANDS OF HESTIA HOME LLC
21800 ALMADEN AVENUE, CUPERTINO
APN 357-15-035
CERTAIN REAL PROPERTY SITUATED IN THE CITY OF CUPERTINO, COUNTY OF SANTA CLARA,
STATE OF CALIFORNIA, MORE PARTICULARLY DESCR IBED AS FOLLOWS ;
BEING A PORTION OF LOT 97, AS SHOWN ON THAT CERTAIN MAP ENTITLED "MAP OF
SUBDIVISION "A" MONTA VISTA," RECORDED IN VOLUME P OF MAPS PAGE 20, SANTA CLARA
RECORDS, AND MORE PARTICULARLY DESCRIBED AS FOLLOWS :
BEGINNING AT THE MOST NORTHWESTERLY CORNER OF SAID PARCEL , THENCE ALONG THE
NORTHERLY LINE OF SAID LOT NORTH 90 °00 '00 " EAST 100.15 FEET TO THE MOST NORTHEAST
CORNER OF SAID LOT;
THENCE ALONG THE EASTERLY LINE OF SAID LOT SOUTH 00 °00'00" EAST 110 .82 FEET TO THE
MOST SOUTHEAST CORNER OF SA ID LOT ;
THENCE ALONG THE SOUTHERLY LINE OF SAID LOT NORTH 90°00'00" WEST 5.00 FEET;
THENCE LEAVING SAID SOUTHERLY LINE AND ACROSS SAID LOT NORTH 00 °00'00" EAST 70.82
FEET PARALLEL WITH AND 5 .00 FEET WESTERLY FROM THE EASTERLY LINE OF SAID LOT,
RIGHT ANGLE MEASURE, TO THE BEGINNING OF A TANGENT CURVE, CONCAVE LEFT;
CONTINUING ALONG SAID TANGENT CURVE HAVING A RADIUS OF 15.00 FEET, THROUGH A
CENTRAL ANGLE OF 90°00'00", AND AN ARC LENGTH OF 23.56 FEET , THENCE NORTH 90 °00 '00"
WEST 80.15 FEET TO A POINT ON THE WESTERLY LINE OF SAID LOT;
THENCE ALONG SAID WESTERLY LINE NORTH 00°00'00" EAST 25.00 FEET TO THE POINT OF
BEGINNING.
CONTAI N ING 2 ,981 .1 4 SQUARE FEET , MORE OR LESS .
SEE EXHIBIT B FOR THE ACCOMPANYING PLAT, ATTACHED HERETO AND MADE A PART
HEREOF.
BASIS OF BEARINGS: THE BEARINGS DESCRIBED IN THIS DESCRIPTION ARE BASED ON THE
CENTERLINE OF ALMADEN AVENUE AS SHOWN ON "SUBDIVISION "A" MONTA VISTA,"
RECORDED IN BOOK P OF MAPS. AT PAGE 20. SANTA CLARA COUNTY RECORDS .
LC ENGINEERING
598 E Santa Clara St, Suite 270 San Jose Phone: (408) 806-7187
EXPIRIATION DATE 12/3 1/2016
SHEET 1 OF 2
Fax : (408) 583-4006
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1' 0 p 0 If) 0
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GRAPHIC SCALE
0 15 30 60
IN FEET )
1 inch = 3 0 ft.
LEGEND & ABBRE~ATIONS
---PARCEL LINE
---PROPERTY LINE
--·-<t---CENTERLINE
it. PROPERTY LINE
POB POINT OF BEGINNING
LOT AREA
EXISTING I 11,098.62± SF
PROPOSED I 8,117.48± SF
EXHIBIT "B"
RIGHT -OF-WAY
DEDICATION
2,981.14 SF
LOT97 / ,w
0 p SUBDIVISION A ,w /' 0
MONTA VISTA 0 ~ p
0 0
0 / U) P MAPS 20 p /
APN 357-15-035 0
2: /
5' / ,.
/
N9o·oo·oo"w
Ge,-)
5.00' ~ fr_ N9o·oo ·o o"w 95.15' /
N9o·oo·oo"E 100.15' _/
APN 357-15-036
BASIS OF BEARINGS
THE BEARINGS SHOWN ON THIS MAP ARE BASED
ON THE CENTERLINE OF ALMADEN AVENUE AS
FOUND MONUMENTED AS TRUE EAST SHOWN ON
"SUBDIVITION A MONTA VIS TA", RECORDED IN
BOOK P OF MAPS, AT PAGE 20, SANTA CLARA
COUNTY RECORDS.
0-'
I
20'
EXHIBI T "B"
ROADWAY DEDICATION
21800 ALMADEN AV ENUE
APN 357-15-035
ENGINEERING
598 E Santa Clara St #270
San Jose, CA 95112
Phone: (408) 806-7187
Fa x: 408 583-4006 Cupertino California
SCALE: 1• = 30 , DA TE: 07 /OB/l 6 DRWG. NAME: PROJECT NO. SHEET 2 OF 2
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CALIFORNIA ALL-PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity
of the individual who signed the document to which this certificate is attached,
and not the truthfulness, accuracy, or validity of that document.
State of California }
County of ~~ ~ }
personally appeared 2 ~ W\Li uJ U.
who proved to me on the basis of satisfactory evidence to be the person(s) whose
name(s) is/are subscribed to the within instrument and acknowledged to me that
he/she/they executed the same in his/her/their authorized capacity(ies), and that by
his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of
which the person(s) acted , executed the instrument.
I certify under PENAL TY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
(Notary Public Sea l)
JULIA KINST
Commission # 2002313
Notary Public -California
Santa Clara County
INSTRUCTIONS FOR COMPLETING THIS FORM
ADDITIONAL OPTIONAL INFORMATION This form complies with current Ca lifornia statutes regarding notmywordingand,
DESCRIPTION OF Tf-jE ATTACHED DOCUMENT
\i\l'-w..L fut ~w
~
( Ue or description of attached ocument)
-uxao ~..+v<..
(Title or description of attached document continued)
Number of Pages _..3_ Document Date I l -\ £ -1 \d
CAPACITY CLAIMED BY THE SIGNER
[$: Individual (s)
D Corporate Officer
(Title)
D Partner(s)
D Attorney -in-Fact
o Trustee(s) o Other _________ _
2015 Version www.NotaryC lasses .com 800-873-9865
if needed, should be co mpleted and attached to th e document. Acknowledgmen ts
from oth er stClles may be co mpleted fo r do cum en ts being sent to that state so long
as th e wording does not require th e California no/(1/y to violate California no/(//)'
law .
• State an d Co unty infonnation must be th e State and County where th e d oc um ent
s igner(s) personally appeared before th e no ta,y public for acknowledgment.
• Date of no tarizati on mu st be th e d ate that the signer(s) personall y appeared which
mu st also be the same date the acknowledgment is completed.
• Th e notary publi c mu st p1int hi s or her name as it appears within hi s or her
co mmi ss ion followed by a comma and th en yo ur title (notaiy public).
• Print th e nam e(s) of document signer(s) who personally appear at the tim e of
notmi za tion .
• Indi cate the coJTect s in gular or plu ral form s by crossing off incoJTect fonns (i.e.
lte/she/they,-is /are) or circling the c01Tec t fonns. Failure to coJTectly indicate thi s
infonnation may lead to rej ec tion of doc um ent recording.
• The notary sea l impress ion must be clear an d photographically reproduc ibl e.
Impression must not cover tex t or lin es . If sea l impress ion smudges, re-seal if a
s uffi cient area pennits, othe,wise complete a different acknowledgment fonn .
• Signature of tb e notary public must match th e signa ture on fi le with the office of
th e county clerk .
••• Addit iona l infonnation is not required but could help to e ns ure this
ac kno wledgment is not mi s used or attac hed to a different document.
•!• b1di cate title or type of at1ach ed document, number of pages and date.
•,• Indicate the capacity claim ed by th e s igner. If the claim ed capacity is a
coqJOrate officer, indicate th e titl e (i.e. CEO, CFO, Secretary).
• Secure ly attach thi s do cum ent to th e s igned document w ith a staple .
CALIFORNIA ALL-PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the identity
of the individual who signed the document to which this certificate is attached,
and not the truthfulness, accuracy, or validity of that document.
State of California }
County of S~ ~ }
0 n __._N--=-<1\J-'---'-._l_~4-, _1:<)~-'-' <.o_ before me, _J~LU....,.:::.:::!-' !.._fA.~IC-::..:t~Nc!,..,,,_...:::_,~T ~-4~~;::X----L~~~
( ere insert name an
personally appeared n 1./V'-N'--~/4-l.v1
who proved to me on the basis of satisfactory evidence to be the person(s) whose
name(s) is/are subscribed to the within instrument and acknowledged to me that
he/she/they executed the same in his/her/their authorized capacity(ies), and that by
his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of
which the person(s) acted, executed the instrument.
I certify under PENAL TY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
(Notary Public Seal)
INSTRUCTIONS FOR COMPLETING THIS FORM
ADDITIONAL OPTIONAL f Nf ORMA TION This fo rm co mplies with current California s tatu/es regarding notary wording and,
DESCRIPTION OF THE ATTACHED DOCUMENT if needed, sho uld be completed and at/ached lo !h e document. Ackno,vledgmenls
:\_ • I , ·,. . 1 • •• r . . C-,n., fi'om oth er s lates may be co mpleted fo r documents being sen t to th at state so long
l~I'-\fl'-tL£...l..-' \ '"' as th e wo rding do es not require th e California nota,y to violate Ca lifornia 11 ota1y
~,®-& 11.)4 t:it Pv,A -~I~ lm v.
(~e or description o ached do cu ~mt) • State and Co un ty infonnation must be th e State and County where th e docum ent
2d g /JV P<l@dCA A,--((, n N ~ '51 , ~. s ign er(s) personally appea red before th e notaiy public for acknowledgment.
~ Date of no tati zati on mus t be th e date th at th e signer(s) personally appeared which
(Title or description of atta ched do cument continued) D ~ 5 mu st a lso be th e same date th e acknow ledg men t is compl eted.
~ • The notaiy publi c mu st piint hi s or her name as it appears within hi s or her
Number of Pages __,_,L_ Document Date / I · f £. I(.:, com mi ss ion fo ll owed by a comma and th en yo ur titl e (nota1y publi c).
CAPACITY CLAIMED BY THE SIGNER
~ Individual (s)
D Corporate Officer
(Title)
D Partner(s)
D Attorney-in-Fact
o Trustee(s) o Other __________ _
2015 Version www.Nota ryClasses .com 800-873-9865
• P1int th e name(s) of do cum ent s ig ner(s) who personally appear at th e tim e of
notaii za ti on.
• Jndi cate th e co ITect sin g ular or plural fonn s by cross in g off in cmTec t fonn s (i.e.
lw/she/t-hey;-is /are) or circ lin g the coITect fo nns. Fai lure to COITectly indi ca te thi s
infonn ati o n ma y lea d to rej ection of docum ent recording .
• The notaiy sea l impress ion must be clear and photogra phi ca ll y re producibl e.
Impress ion mu st not cover text o r lin es. If sea l impress io n smudges, re-sea l if a
s uffi cie nt area pennilS , otherwise complete a different ac kno w ledgment fo nn .
• S igna ture of th e nota1y publi c mu st match th e signature on fil e with th e office of
th e county clerk.
•:• Additiona l infonnation is not required bu t could help to ensure thi s
acknowledgment is not mi s use d or attached to a different doc um ent.
•:• Indi cate title or type of attached docum ent , number of pages and date.
•:• Indi cate th e capacity claimed by th e signer. If the claimed capacity is a
coqiorate officer, indi cate th e titl e (i .e. CEO, CFO, Secre taiy).
• Sec urely attach thi s docum e nt to th e signed document with a stapl e.
DOCUMENT: 23396330 Pages : 7
RECORDING REQUESTED BY :
11 /l II I II I llUI 11111111111 11111
Fees • No Fees
City of Cupertino
WHEN RECORDED, MAIL TO:
City Clerk's Office
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
REGINA AL COM ENDRAS
SANTA CL ARA COUN TY RE CORD ER
Re corded at the r e qu est of
ci t y
Taxes .
Cop ies
AMT PAID
RDE J:t 025
8/1 0/2016
2 : 18 PM
(SPACE ABOVE THIS LINE FOR RECORDER'S USE)
NO FEE IN ACCORDANCE
WITH GOV. CODE 27381
DEDICATION IN FEE
FOR ROADWAY PURPOSES
21800 Almaden Avenue, Cupertino, CA 95014
APN 375-15-035
Original
D For Fast Endorsement
"NO FEE"
City of Cupertino
CERTIFICATE OF ACCEPTANCE is hereby given in order to comply with the
provisions of Section 27381 of the Government Code.
This is to certify that the interest in real property conveyed by the deed or grant
dated July 13, 2016, from
21800 Almaden A venue, Cupertino, CA 95014
to the City of Cupertino, a governmental agency, is hereby accepted by order of the Public
Works Director, and the grantee consents to recordation thereof by its duly authorized
officer.
Dated: July 21, 2016
By: or5w__g~~-
Lauren Sapudar
Senior Office Assistant
DEDICATION IN FEE
FOR ROADWAY PURPOSES
21800 Almaden Avenue, Cupertino CA 95014
APN 375-15-035
Hestia Home LLC, a California limited liability company, dedicates in fee to the CITY OF
CUPERTINO, a California municipal corporation, for public purposes including, but not limited
to roadway purposes, together with the right to construct, repair, operate , and maintain any and
all public utilities and improvements in , on , under , along and across the real property which shall
be or become necessary for preservation of the public safety, welfare or convenience, the real
property described in Exhibit A and shown in Exhibit B, which is situated in the City of
Cupertino, County of Santa Clara, State of California.
IN WITNESS WHEREOF, executed this / 3 day of ~ 2016.
Owner:
Zhimei Wu
Executive Manager
City of Cupertino:
~-/
Director of Public Works
(Notary acknowledgment to be attached)
EXHIBIT "A"
LEGAL DESCRIPTION
ROADWAY DEDICATION
LANDS OF HESTIA HOME LLC
21800 ALMADEN AVENUE, CUPERTINO
APN 357-15-035
CERTAIN REAL PROPERTY SITUATED IN THE CITY OF CUPERTINO , COUNTY OF SANTA CLARA,
STATE OF CALIFORNIA, MORE PARTICULARLY DESCRIBED AS FOLLOWS ;
BEING A PORTION OF LOT 97, AS SHOWN ON THAT CERTAIN MAP ENTITLED "MAP OF
SUBDIVISION "A" MONTA VISTA," RECORDED IN VOLUME P OF MAPS PAGE 20, SANTA CLARA
RECORDS, AND MORE PARTICULARLY DESCRIBED AS FOLLOWS :
BEGINNING AT THE MOST NORTHWESTERLY CORNER OF SAID PARCEL , THENCE ALONG THE
NORTHERLY LINE OF SAID LOT NORTH 90 °00 '00 " EAST 100.15 FEET TO THE MOST NORTHEAST
CORNER OF SAID LOT ;
THENCE ALONG THE EASTERLY LINE OF SAID LOT SOUTH 00 °00'00 " EAST 110 .82 FEET TO THE
MOST SOUTHEAST CORNER OF SAID LOT;
THENCE ALONG THE SOUTH ERL y LINE OF SAID LOT NORTH 90 °00 '00 " WEST 5.00 FEET;
THENCE LEAVING SAID SOUTHERLY LINE AND ACROSS SAID LOT NORTH 00 °00 '00" EAST 70.82
FEET PARALLEL WITH AND 5.00 FEET WESTERLY FROM THE EASTERLY LINE OF SAID LOT,
RIGHT ANGLE MEASURE , TO THE BEGINNING OF A TANGENT CURVE , CONCAVE LEFT;
CONTINUING ALONG SAID TANGENT CURVE HAVING A RADIUS OF 15 .00 FEET , THROUGH A
CENTRAL ANGLE OF 90 °00 '00", AND AN ARC LENGTH OF 23 .56 FEET , THENCE NORTH 90 °00'00"
WEST 80 .15 FEET TO A POINT ON THE WESTERLY LINE OF SAID LOT ;
THENCE ALONG SAID WESTERLY LINE NORTH 00 °00 '00 " EAST 25 .00 FEET TO THE POINT OF
BEGINNING .
CONTAINING 2 ,981.14 SQUARE FEET, MORE OR LESS .
SEE EXHIBIT B FOR THE ACCOMPANYING PLAT, ATTACHED HERETO AND MADE A PART
HEREOF.
BASIS OF BEARINGS: THE BEARINGS DESCRIBED IN THIS DESCRIPTION ARE BASED ON THE
CENTERLINE OF ALMADEN AVENUE AS SHOWN ON "SUBDIVISION "A" MONTA VISTA,"
RECORDED IN BOOK P OF MAPS, AT PAGE 20, SANTA CLARA COUNTY RECORDS .
EXPIRIATION DATE 12/31/2016
LC ENGINEERING SHEET 1OF2
598 E Santa Clara St , Suite 270 San Jose Phone : (408) 806-7187 Fa x: (408) 583 -4006
EXHIBIT "B"
ALMADEN AVENUE
POB N9o·oo ·oo"E 100.15 • -----<f:-------
---------1 -• f[_ N9o·oo·oo"w 80.15' %
GRAPHIC SCALE
0 15 JO
( IN FEET )
1 inch = 30 ft.
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LEGEND & ABBRE~ATIONS
---PARCEL LINE
---PROPERTY LINE
--~--CENTERLIN E
ft_ PROPERTY LINE
POB POINT OF BEGINNING
LOT AR EA
EXISTING I 11,098.62± SF
PROPOSED I 8,117.48± SF
L=2J.56', R=15.00'
b.=9o ·oo·oo", T=15.oo·
RIGHT-OF-WAY
DEDICATION
2,981.14 SF
LOT97
SUBDIVISION A
MONTA VISTA
P MAPS 20
APN 357-15-035
N9o·oo·oo"w
5 .00'
f[_ N9o·oo·oo"w 95 .15'
N9o·oo·oo"E 100.15·
APN 357-15-036
BASIS OF BEARINGS
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THE BEARINGS SHOWN ON THIS MAP ARE BASED
ON THE CENTERLINE OF ALMADEN AVENUE AS
FOUND MONUMENTED AS TRUE EAST SHOWN ON
"SUBDIVITION A MONTA VISTA'', RECORDED IN
BOOK P OF MAPS, A T PAGE 20, SANTA CLARA
COUN TY RECORDS.
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EXHIBIT "8"
ROADWAY DEDICATION
21800 ALMADEN AVENUE
APN 357-15-035
ENGINEERING
Cu ertino
SCALE: 1• = 30, DATE :Ol/OB/lS DRWG . NAME: PROJECT NO .
California
SHEET 2 OF 2
598 E Santa Clara St #270
San Jose, CA 95112
Phone: ( 408) 806-7187
Fax: 408 583-4006
CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT
I
A notary public or other officer completing this certifi ca te verifies o nly the identity of the ind ividual who signed the document to
which this certificate is attach ed, and n ot th e truthfulness, accu r acy, or validity of th at document.
State of California
County of ---=_s'---~-'-V\_.-Y.~"t-.._<:._\ tVL. __ ,_:i... __
On Jv-.1.i 1 \3~. ·10 \(:, before me, ----~~~\~W\~q_-~-~~-J~· _t'_1~------' Notary Public,
(H ere in se rt name and tit le of th e officer)
personally appeared __________ ~_\_,_\_~-~-'-\_,-~-~---------------~·
who proved to me on the basis of satisfactory evidence to be the personts)" whose nam ~) isjare subscribed to
the within instrument and acknowledged to me that)relsheMre'y executed the same in .J:riS/her~r authorized
capacity(.iesJ, and that by ,h.fSi'her/tJ;relr signature(.8-) on the instrument the person(s), or the entity upon behalf of
which the person (,sYacte d , executed the instrument.
I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand a~~al.
Signa tu re of Notary Public /
Ja NIMESH J. PATEL ~ Commluion # 2143752
j • Notary Public · C11iforni1
z S1nt1 Clara County ..
(Notary Seal) ) , u o u o oMl S0T"! tx~r:s ~~ ;,o}i2&J
ADDITIONAL OPTIONAL INFORMATION
DESCRJPTION OF THE A TT ACHED DOCUMENT
J?e.A-lc_.i-tic v,\~ ~ ~c~<l.-e -'\
(Title or desc ription of attac hed document) 1
(Ti ll e or de sc ription of attached docu ment co ntinued)
N umber of Pages __}__ Document Date 7 { 1.3 /t.c 1-b
(Additi onal information)
CAP~Y CLAIMED BY THE SIGNER
L!1 Individual (s)
D Corporate Officer
(Ti tl e)
D Partner(s)
D Attorney-in-Fact
D Trustee(s)
D Other ___________ _
INS TRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in Ca lifornia must contain verbiage exactly as
appears abo ve in the notmy section or a separate acknowledgment form mu st be
properly completed and al/ached to that doc ument. The on ly exception is if a
document is to be recorded outside of Ca lifornia. In 3uch in stances, any altern ati ve
acknowledgment verbiage as may be printed on such a document so long as th e
verbiage does not require th e notmy to do something that is illegal for a notmy in
California (i.e. certifaing the authori ze d capacity of the signe1). Please check th e
docume nt careji1/ly fo r proper notarial wordin g and al/ach this form if required.
• State and Cou nty information mu sl be th e State and County where th e document
signer(s) personall y appeared befo re th e not ary public for acknowledgment.
• Date of notarization must be th e dat e th at th e signer(s) personal ly app ea red which
mu st als o be th e sa me date th e acknow ledg ment is comp leted.
• The notary public mu st print hi s or her name as it appears with in hi s or her
comm iss ion followed by a co mm a and then your title (notary public).
• Print th e nam e(s) of docum ent signe r(s) who personall y app ea r at the tim e of
notari za tion .
• Indi cate th e correct sing ul ar or plural forms by cross ing off in co rr ect form s (i .e.
tte/s he/llley;-is /are) or ci rclin g th e correc t form s. Failure to correctl y indi cate thi s
information ma y lead to rejection of document rec ording .
• The notary sea l impress ion must be clear and pho tograp hi ca ll y rep roducibl e.
Impressio n mu st not cover tex t or lin es. If sea l impress ion smud ges, re-sea l if a
suffi cient area pe rmit s, oth erw ise comp lete a different acknowledgment form .
• Sig nature of the notary public mu st match th e sig nature on file with the office of
th e county clerk .
•!• Additio nal infonnati on is not req uir ed but cou ld help to ensur e thi s
ack no wledgment is not mi suse d or atta ched to a different docum ent.
•!• Indicate title or type of attac hed document, numb er of pag es and dat e.
•!• Indicate th e capacity claim ed by th e s igner. If th e claim ed capac ity is a
corpora te officer, indic ate th e titl e (i.e. CEO , CFO, Secretary).
• Secure ly attac h thi s docum ent to th e signed document
C 2004-2015 ProLink Sig nin g Service, Inc. -All Right s Reserve d www.T heProLi nk.com -Na ti onw ide Notary Serv ice
CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies o nly the iden tity of the individual who s igned th e d ocument to
w hich this certificate is attach ed, and not the truthfu lness, accuracy, or validity of th at docum ent.
State of California
County of --=-Set""--"'-'-n tf\-'-"--'---=C__,_l C\._V"V1---"-'---
On Jv\ \~ 2\ 1 W\ lo before me, ____ Cv-=--,--~l leMJ~=---'-''---"""U,~ijy\)""T+-'~:,.0~,,-------' Notary Public ,
(Here in se rt name and titl e of th e officer)
personally appeared _____ ]J ___ i·m~m~-'B~11~df-O~'-"--!~--------------
who proved to me on the basis of satisfactory evidence to be th ~(s) whos ~(s) ~re subscribed to
the within instrument and acknowledged to me that ~she/they executed the same in ~er/their authorized
~ies), and that by ~er/their~(s) on the instrument th ~s), or the entity upon behalf of
~h ~) acted, executed th~ment.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
(Notary Seal)
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
(Title or description of attached document)
(Title or description of attached do cument continued)
Number of Pages __ Document Date ____ _
(Additional informati on)
CAP A CITY CLAIMED BY THE SIGNER
D Individual (s)
D Corporate Officer
(Title)
D Partner(s)
D Attorney-in-Fact
D Trustee(s)
D Other ___________ _
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in Ca lifornia must contain verbiage exactly as
appears above in the notary section or a separate acknowledgment form must be
properly comp leted and atta ched to that document. The only excep tion is if a
do cum en t is to be recorded outside of California. In such instances, any alternative
acknow ledgment verb iage as may be printed on such a document so long as th e
verbiage does not req uire the notary to do something th at is illegal for a notary in
Californ ia (i.e. certifYing the au th orized capacity of the signer). Please check th e
document carefully for proper notarial wording and attach this form if required.
• State and Co un ty information mu st he the State and County where th e doc ument
signer(s) personally appeared before the notary public for acknowledgm ent.
• Date of notarizati on must be th e date that th e signer(s) personally appeared which
must also be the sa me date th e acknowledgment is co mpl eted.
• The notary public must print hi s or her name as it appears within hi s or her
commission followed by a co1runa and then yo ur title (notary public).
• Print the name(s) o f docwnent sign er(s) who personally appear at the time of
notarization .
• Indic ate the co rrec t singul ar or plural forms by crossing off incorrect forms (i.e.
he/she/they, is /are) or circling the correc t fonns . Fail ure to correctly indicate thi s
inform ati on ma y lead to rejection of docwnent recording.
• The notary seal impression mu st be clear and photographically reprod uci ble.
Impress ion must not cover text or lin es. If sea l impressio n smudges, re-sea l if a
suffi cient area permits , otherwise complete a different acknowledgment form .
• Signature o f th e notary public mu st match th e s ignature on file with th e office of
th e county c lerk .
•!· Additional information is not required but co uld he lp to ensure thi s
acknow ledg ment is not mi sused or attached to a di fferent docum ent.
•!• Indi cate title or ty pe of attached document, number of pages and date .
•:• Indi cate the capacity cl a im ed by th e signer. If the claimed capacity is a
corporate office r, indicate th e title (i.e. CEO , CFO, Secretary).
Sec ure ly attac h this docu ment to th e sig ned document
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