COPY CERTIFICATION BY DOCUMENT CUSTODIAN



COPY DECLARATION BY DOCUMENT CUSTODIAN

Date: ____________________________

I, _________________________________, hereby declare that the attached reproduction of __________________________________________ is a copy of the original document in my possession or control.

DETAILS OF ORIGINAL DOCUMENT(S)

Document Number(s)

Date(s) issued

Issued by

Pages attached (excluding any Apostille or Authentications)

Signature of Custodian of Original Document

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State of New York )

)ss

County of )

Subscribed and sworn to (or affirmed) before me on this ___ day of __________, 20___,

by _________________________________________, personally known to (or proved to me on the basis of satisfactory evidence to be) the person who appeared before me, and thereby executed same.

___________________________________________

Signature of Notary Public

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