D-1010 Lot Line Adjustment, Srinithyaa Parthasarathy & Vijaya Sarathy Kasi, APN 357-18-005RECORDING REQUESTED BY:
FIDELITY NATIONAL TITLE
RECORDING REQUESTED BY:
City of Cupertino
WHEN RECORDED MAIL TO:
City Clerk
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
NO FEE IN ACCORDANCE
WITH GOV. CODE 6103
"This document was electronically submitted
to Santa Clara County for recording"
25804747
Regina Alconnendras
Santa Clara County - Clerk -Recorder
05/09/2025 12:01 PM
Titles:1 Pages:7
Fees: $0.00
Tax: $0
Total: $0.00
(SPACE ABOVE THIS LINE FOR RECORDER'S USE)
LOT LINE ADJUSTMENT
(Lot Merger)
Srinithyaa Parthasarathy and Vijaya Sarathy Kasi, wife and husband as joint
tenants
APN: 357-18-005
E4iginal
Conformed Copy
LOT LINE ADJUSTMENT
Property Owners: Srinithyaa Parthasarathy and Vijaya Sarathy
Kasi
APN: 357-18-005
ACTION BY THE CITYENGINEER APPROVING A LOT LINE ADJUSTMENT BETWEEN
TWO ADJACENT PARCELS
BE IT RESOLVED BY THE CITY ENGINEER OF THE CITY OF CUPERTINO:
A request for a lot line adjustment between two parcels located on APN 357-18-005 as
shown on the attached hereto plat marked Exhibit "A" and legal description marked Exhibit `B",
has been submitted by the record owner(s) of the above property of the City of Cupertino with
the request that an adjustment of lot lines, as described in Exhibit "C", be approved by the City
Engineer.
The City Engineer hereby finds that the lot line removal requested is between two
adjacent parcels, that the land taken from one of the parcels is added to the adjacent parcel and
that a greater number of parcels than originally existed would not be created.
Based on the above facts and findings and by the authority of Section 18.08.040C of the
City of Cupertino Municipal Code and Section #66412d of the Subdivision Map Act, said lot line
adjustment is hereby approved.
Approved this - n day of Iq 1p)e � L
LIM
City Engineer
City of Cupertino
RCE 66077
BASIS OF BEARINGS
THE BEARINGS SHOWN HEREON ARE BASED
ON THE CENTERLINE OF LOMITA AVENUE OF
PARCEL MAP FILED DECEMBER 16, 2010 IN
BOOK 840 OF MAPS AT PAGES 47-48,
SANTA CLARA COUNTY RECORDS, AS
S89'55'14"E
FOUND 3.0" BRASS
DISK AND PUNCH IN
MONUMENT WELL
AT GRANADA STREET
LOMITA AVENUE (60s)
CENTERLINE I
N00'04 46 E 1
30.00'-\I
POINT OF BEGINNING 1
(MERGED PARCELS)
I
S89'55'14"E 60.02'
30.00' _ 30.02'
POINT OF (30.00')
BEGINNING
(PARCEL ONE
�A & TWO) c o
3�
OI N
S�
o �
0
z
I�
N89'55'14"W
34.96'
0
n�o 1 O Im
Na S M2 co 1 ^ 1 o
�X gF wl°m' g is ° w Z
OF CA��� al:
U115 ) W � U N rn �
m ,� w
0 2iIL 0 3 ��zo W Z
�'a I-I.�
'n a c u
z I o z to °' 9t o �
(�Q�1DS a01� 1 0 1 c d'
PORTION OF IZ LOT D ton
BROWN MIn N LOT C BLOCK 8 �
BLOCK 8 1 P MAPS 24 w
P MAPS 24 ( a
30.02'
30.00' _ _ 30.00' �
N89'55'30"W 60.02' 1�-1
0 15 30 60
LAMBS OF
SCALE: 1" = 30' �Q�Q�OC�Q 3
CMpCWNG 0 Lo
BOUNDARY NOTE OO�M�] DQ�1 WC o I
THE BOUNDARY SHOWN HEREON FOUND 3.0" BRASS z
IS BASED UPON A FIELD
SURVEY. RECORD DATA PER 'P' DISK AND PUNCH IN
MAPS 24, SANTA CLARA MONUMENT WELL AT
PARENTTHERECORDS, IS SHOWN IN OLIVE STREET
LEA & BRAZE ENGINEERING, INC. EXHIBIT 'A'
ORIGINAL AND MERGED
CIVIL ENGINEERS • LAND SURVEYORS LOT CONFIGURATIONS,
BAY AREA REGION SACRAMENTO REGION
2495 INDUSTRIAL PKWY WEST 3017 DOUGLAS BLVD, i 300 APN: 357-18-005, CUPERTINO,
HAYWAR94545 ROSEVILLE, CA 95661 SANTA CLARA COUNTY, CALIFORNIA
(P) (510 887-408) 887-4086 (P) (918)968-1338
(F) (510) 887WWw LEABRAZE.C9OM797-7383 JOB NO 2200255 SCALE: 1 "= 30'
DRAWN BY PCW PAGE 1 OF 3 APRIL 2025
EXHIBIT `B'
LEGAL DESCRIPTION FOR
ORIGINAL CONFIGURATION, PARCELS ONE AND TWO
APN: 357-15-005, CUPERTINO
SANTA CLARA COUNTY, CALIFORNIA
All that certain real property, situate in the City of Cupertino, Santa Clara County, State of
California being all of Parcel One and Parcel Two of the Lands of Parthasarathy and Kasi, as
described in that certain Grant Deed filed February 17, 2021 as Document Number 24835707
Official Records of Santa Clara County, more particularly described as follows:
Parcel One:
Beginning at the Northwest corner of said Parcel One, said point also being on the South Right
of Way line of Lomita Avenue, 60 feet in width;
Thence along the North line of said parcel coincident with said south right of way line,
South 89°55' 14" East, 30.02 feet to the Northeast corner of said parcel, said corner is also being
the intersection of said South Right of Way line of Lomita Avenue with the West Right of Way
line of Imperial Avenue, 70 feet in width;
Thence along the East line of said parcel coincident with said west right of way line,
South 00°00'07" East, 95.96 feet to the Southeast corner of said parcel,
Thence along the South line of said parcel, North 89°55'30" West, 30.01 feet to the Southwest
corner of said parcel;
Thence along the West line of said parcel, North 00°00'05" West, 95.96 feet to the Point of
Beginning.
Containing 2,881 Square Feet more or less.
Parcel Two:
Beginning at the Northeast corner of said Parcel Two,
Thence along the East line of said parcel, South 00°00'05" East, 95.96 feet to the Southeast
corner of said parcel;
Thence along the South line of said parcel, North 89°55'30" West, 30.00 feet to the Southwest
corner of said parcel;
Thence along the West line of said parcel, North 00°00'05" West, 95.96 feet to the Northwest
corner of said parcel, said point also being on the South Right of Way line of Lomita Avenue, 60
feet in width;
Thence along the North line of said parcel coincident with said south right of way,
South 89°55' 14" East, 3 0. 00 feet to the Point of Beginning.
Containing 2,879 Square Feet more or less.
\\HAY-FILE\Projects\projects\2020_JOBS\2200255 SU\LOT MERGER DOCS\working\EXHIBIT B r2.docx
Page 2 of 3
EXHIBIT `B'
LEGAL DESCRIPTION FOR
ORIGINAL CONFIGURATION, PARCELS ONE AND TWO
APN: 357-18-005, CUPERTINO
SANTA CLARA COUNTY, CALIFORNIA
(continued)
As shown on plat attached hereto labeled Exhibit "A" and by this reference made a part hereof.
The bearings described are based on the centerline of Lomita Avenue, as shown on the certain
Parcel Map, filed December 16, 2010 in Book 840 of Maps at pages 47-48, Santa Clara County
Records, being South 89°55' 14" East.
END OF DESCRIPTION
r
\\HAY-FILE\Projects\projects\2020_J0B5\2200255 SU\LOT MERGER DOCS\working\EXHIBIT B r2.docx
0. 8162
0
FOFCA\,
Page 2 of 3
EXHIBIT `C'
LEGAL DESCRIPTION FOR
MERGED CONFIGURATION, PARCEL ONE AND TWO
APN: 357-18-005, CUPERTINO
SANTA CLARA COUNTY, CALIFORNIA
All that certain real property, situate in the City of Cupertino, Santa Clara County, State of
California being all of Parcel One and Parcel Two of the Lands of Parthasarathy and Kasi, as
described in that certain Grant Deed filed February 17, 2021 as Document Number 24835707
Official Records of Santa Clara County, more particularly described as follows:
Beginning at the Northeast corner of said Parcel One, said point being the intersection of the
South Right of Way line of Lomita Avenue, 60 feet in width, with the West Right of Way line of
Imperial Avenue, 70 feet in width;
Thence along the East line of said parcel coincident with said west right of way line,
South 00°00'07" East, 95.96 feet to the Southeast corner of said parcel;
Thence along the South line of said Parcel One and continuing along the South line of said
Parcel Two, North 89°55'30" West, 60.02 feet to the Southwest corner of said Parcel Two;
Thence along the West line of said Parcel Two, North 00°00'05" West, 95.96 feet to the
Northwest corner of said Parcel Two;
Thence along the North line of said Parcel Two and continuing along the North line of said
Parcel One, coincident with said south right of way line, South 89°55' 14" East, 60.02 feet to the
Point of Beginning.
Containing 5,760 Square Feet more or less.
As shown on plat attached hereto labeled Exhibit "A" and by this reference made a part hereof.
The bearings described are based on the centerline of Lomita Avenue, as shown on the certain
Parcel Map, filed December 16, 2010 in Book 840 of Maps at pages 47-48, Santa Clara County
Records, being South 89°55' 14" East.
END OF DESCRIPTION
PREEPARED BY OR UNDER THE DIRECTION OF:
PATR'ICKLC. WEBER
L 8162
\\HAY-FILE\Projects\projects\2020 JOBS\2200255 SU\LOT MERGER DOCS\working\EXHIBIT C r2.docx
Page 3 of 3
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 Santa Clara
On April 22, 2025
before me, Kirsten Squarcia
(Here insert name and title of the officer)
personally appeared Chad Mosley
Notary Public,
who proved to me on the basis of satisfactory evidence to be the personH 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{-ie,$), and that by his/her/their signature() on the instrument the person{}, or the entity upon behalf of
which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
Signs re of Notary Public
�� os ry KIRSTEN SQUARCIA
.T Notary Public - California
Santa Clara County
Commission # 2431589
r,.o •`� My Comm. Expires Dec 19, 2026
(Notary Seal)
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
(Title or description of attached document)
(Title or description of attached document continued)
Number of Pages Document Date
(Additional information)
CAPACITY CLAIMED BY THE SIGNER
❑ Individual (s)
❑ Corporate Officer
(Title)
❑ Partner(s)
❑ Attorney -in -Fact
❑ Trustee(s)
❑ Other
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California mast contain verbiage exactly as
appears above in the notary section or a separate acknowledgment form must be
properly completed and attached to that document. The only exception is if a
document is to be recorded outside of California. In such instances, any alternative
acknowledgment verbiage as may be printed on such a document so long as the
verbiage does not require the notary to do something that is illegal for a notary in
California (i.e. certifying the authorized capacity of the signer). Please check the
document carefully for proper notarial wording and attach this form if required.
• State and County information must be the State and County where the document
signer(s) personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s) personally appeared which
must also be the same date the acknowledgment is completed.
• The notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title (notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
notarization.
• Indicate the correct singular or plural fors by crossing off incorrect forms (i.e.
he/she/the},-- is /are ) or circling the correct forms. Failure to correctly indicate this
information may lead to rejection of document recording.
• The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges, re -seal if a
sufficient area permits, otherwise complete a different acknowledgment for.
• Signature of the notary public must match the signature on file with the office of
the county clerk.
Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
Indicate title or type of attached document, number of pages and date.
Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (i.e. CEO, CFO, Secretary).
• Securely attach this document to the signed document
C 2004-2015 ProLink Signing Service, Inc. — All Rights Reserved www.TheProLink.corn — Nationwide Notary Service
RECORDING REQUESTED BY:
FIDELITY NATIONAL TITLE
RECORDING REQUESTED BY:
City of Cupertino
WHEN RECORDED MAIL TO:
City Clerk
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
(SPACE ABOVE THIS LINE FOR RECORDER'S USE)
NO FEE IN ACCORDANCE
WITH GOV. CODE 6103
LOT LINE ADJUSTMENT
(Lot Merger)
Srinithyaa Parthasarathy and Vijaya Sarathy Kasi, wife and husband as joint
tenants
APN: 357-18-005
Original
ZConformed Copy
LOT LINE ADJUSTMENT
Property Owpers: Srinithyaa Parthasarathy and Vijaya Sarathy
Kasi
APN: 357-18-005
ACTIONBY THE CITYENGINEER APPROVING A LOT LINE ADJUSTMENT BETWEEN
TWO ADJACENT PARCELS
BE IT RESOLVED BY THE CITY ENGINEER OF THE CITY OF CUPERTINO:
A request for a lot line adjustment between two parcels located on APN 357-18-005 as
shown on the attached hereto plat marked Exhibit "A" and legal description marked Exhibit `B",
has been submitted by the record owner(s) of the above property of the City of Cupertino with
the request that an adjustment of lot lines, as described in Exhibit "C", be approved by the City
Engineer.
The City Engineer hereby finds that the lot line removal requested is between two
adjacent parcels, that the land taken from one of the parcels is added to the adjacent parcel and
that a greater number of parcels than originally existed would not be created.
Based on the above facts and findings and by the authority of Section 18.08.040C of the
City of Cupertino Municipal Code and Section #66412d of the Subdivision Map Act, said lot line
adjustment is hereby approved.
Approved this 2 z n day of
City Engineer
City of Cupertino
RCE 66077
BASIS OF BEARINGS
THE BEARINGS SHOWN HEREON ARE BASED
ON THE CENTERLINE OF LOMITA AVENUE OF
PARCEL MAP FILED DECEMBER 16, 2010 IN
BOOK 840 OF MAPS AT PAGES 47-48,
SANTA CLARA COUNTY RECORDS, AS
S89'55'14"E
FOUND 3.0" BRASS
DISK AND PUNCH IN
MONUMENT WELL
AT GRANADA STREET
LOMITA
AVENUE
(609)
— —
CENTERLINE
N00'04'46"E
1
30.00'—\I
POINT OF BEGINNING
(MERGED PARCELS)
I
S89'55'14"E
60.02'
30.00' I
30.02'
POINT OF /
(30.00')
0
�9y
BEGINNING
(PARCEL ONE
`
& TWO) 0
0
t�0 I 0 '0
No. 81e2 CD
Ln
---Acr>2rr �0I'(o F eqw
Lo
c1F o
Ops l� ` 3 p X 0 U < 0 m
mlrn mmN�•I O�
xz
o W
u�
01 ®" Z0 o
10
LANDS Op z o = 0 10
PORTION OF 10 LOT D 6 v0i
o p
00 muu INV, G\lj
LOT C Z
BLOCK 8
BLOCK 8 I
P MAPS 24
P MAPS 24
30.02'
30.00' I ®
30.00'
N89'55'30"W
60.02'
SCALE: 1" = 30'
THE BOUNDARY SHOWN HEREON
IS BASED UPON A FIELD
SURVEY. RECORD DATA PER 'P'
MAPS 24, SANTA CLARA
COUNTY RECORDS, IS SHOWN IN
PARENTHESIS.
f
LANDS OF
SARA 0aA
OMpMTWO
OOLUM o oar HC
LEA & BRAZE ENGINEERING, INC.
. ..........
CIVIL ENGINEERS LAND SURVEYORS
BAY AREA REGION SACRAMENTO REGION
2495 INDUSTRIAL PKWY WEST 3017 DOUGLAS BLVD, # 300
HAYWARD, CALIFORNIA 94545 ROSEVILLE, CA 95661
(P) (510) 887-4086 (P) (916)966-1338
(F) (510) 887-3019 (F) (916)797-7363
WWW.LEABRAZE.COM
FOUND 3.0" BRASS
DISK AND PUNCH IN
MONUMENT WELL AT
OLIVE STREET
3�
oI N
ui
o
0
z
I�
N89'55'14"W
34.96'
ORIGINAL AND MERGED
LOT CONFIGURATIONS,
APN: 357-18-005, CUPERTINO,
SANTA CLARA COUNTY, CALIFORNIA
JOB NO 2200255
SCALE: 1 "= 30'
DRAWN BY PCW PAGE 1 OF 3 APRIL 2025
EXHIBIT `B'
LEGAL DESCRIPTION FOR
ORIGINAL CONFIGURATION, PARCELS ONE AND TWO
APN: 357-18-005, CUPERTINO
SANTA CLARA. COUNTY, CALIFORNIA
All that certain real property, situate in the City of Cupertino, Santa Clara County, State of
California being all of Parcel One and Parcel Two of the Lands of Parthasarathy and Kasi, as
described in that certain Grant Deed filed February 17, 2021 as Document Number 24835707
Official Records of Santa Clara County, more particularly described as follows:
Parcel One:
Beginning at the Northwest corner of said Parcel One, said point also being on the South Right
of Way line of Lomita Avenue, 60 feet in width;
Thence along the North line of said parcel coincident with said south right of way line,
South 89°55' 14" East, 30.02 feet to the Northeast corner of said parcel, said corner is also being
the intersection of said South Right of Way line of Lomita Avenue with the West Right of Way
line of Imperial Avenue, 70 feet in width;
Thence along the East line of said parcel coincident with said west right of way line,
South 00000'07" East, 95,96 feet to the Southeast corner of said parcel;
Thence along the South line of said parcel, North 89°55'30" West, 30.01 feet to the Southwest
corner of said parcel;
Thence along the West line of said parcel, North 00°00'05" West, 95.96 feet to the Point of
Beginning.
Containing 2,881 Square Feet more or less.
Parcel Two:
Beginning at the Northeast corner of said Parcel Two,
Thence along the East line of said parcel, South 00°00'05" East, 95.96 feet to the Southeast
corner of said parcel;
Thence along the South line of said parcel, North 89°55'30" West, 30.00 feet to the Southwest
corner of said parcel;
Thence along the West line of said parcel, North 00°00'05" West, 95.96 feet to the Northwest
corner of said parcel, said point also being on the South Right of Way line of Lomita Avenue, 60
feet in width;
Thence along the North line of said parcel coincident with said south right of way,
South 89°55' 14" East, 30.00 feet to the Point of Beginning.
Containing 2,879 Square Feet more or less.
\\HAY-FILE\Projects\projects\2020_JOBS\2200255 SU\LOT MERGER DOCS\working\EXHIBIT B rldocx
Page 2 of 3
11.LSSi1LIlJlDI 'B'
LEGAL DESCRIPTION FOR
ORIGINAL CONFIGURATION, PARCELS ONE AND TWO
APN: 357-I8-005, CUPERTINO
SANTA CLARA COUNTY, CALIFORNIA
(continued)
As shown on plat attached hereto labeled Exhibit "A" and by this reference made a part hereof.
The bearings described are based on the centerline of Lomita Avenue, as shown on the certain
Parcel Map, filed December 16, 2010 in Book 840 of Maps at pages 47-48, Santa Clara County
Records, being South 89°55' 14" East.
END OF DESCRIPTION
ON, FAIN
MIT'
1'.
a
\\HAY-FILE\Projects\projects\2020_JOBS\2200255 SU\LOT MERGER DOCS\working\EXHIBIT B r2,docx
try
o. 8169
CF CP
Page 2 of 3
EXHIBIT `C'
LEGAL. DESCRIPTION FOR
MERGED CONFIGURATION, PARCEL ONE AND TWO
APN: 357-18-005, CUPERTINO
SANTA CLARA COUNTY, CALIFORNIA
All that certain real property, situate in the City of Cupertino, Santa Clara County, State of
California being all of Parcel One and Parcel Two of the Lands of Parthasarathy and Kasi, as
described in that certain Grant Deed filed February 17, 2021 as Document Number 24835707
Official Records of Santa Clara County, more particularly described as follows:
Beginning at the Northeast corner of said Parcel One, said point being the intersection of the
South Right of Way line of Lomita Avenue, 60 feet in width, with the West Right of Way line of
Imperial Avenue, 70 feet in width;
Thence along the East line of said parcel coincident with said west right of way line,
South 00°00'07" East, 95.96 feet to the Southeast corner of said parcel;
Thence along the South line of said Parcel One and continuing along the South line of said
Parcel Two, North 89°55'30" West, 60.02 feet to the Southwest corner of said Parcel Two;
Thence along the West line of said Parcel Two, North 00°00'05" West, 95.96 feet to the
Northwest corner of said Parcel Two;
Thence along the North line of said Parcel Two and continuing along the North line of said
Parcel One, coincident with said south right of way line, South 89°55' 14" East, 60.02 feet to the
Point of Beginning.
Containing 5,760 Square Feet more or less.
As shown on plat attached hereto labeled Exhibit "A" and by this reference made a part hereof.
The bearings described are based on the centerline of Lomita Avenue, as shown on the certain
Parcel Map, filed December 16, 2010 in Book 840 of Maps at pages 47-48, Santa Clara County
Records, being South 89055' 14" East.
END OF DESCRIPTION
PREEPARED BY OR UNDER THE DIRECTION OF:
- P
r
e 3 0. 81 '2 r
PA RICK . WEBER
L 8162�\ cr= Ch'�%
r
\\HAY-FILE\Projects\projects\2020 JOBS\2200255 SU\LOT MERGER DOCS\working\EXHIBIT C r2.docx
Page 3 of 3
CAM FORMA ALL-PURPOSE CERTI FffCATIE OF A KNO WLEDG MIIENT
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
Santa Clara
On April 22, 2025 before me, Kirsten Squarcia , Notary Public,
(Here insert name and title of the officer)
personally appeared Chad Mosley
who proved to me on the basis of satisfactory evidence to be the person(e) 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(-ie, ), and that by his/her/their signature(( on the instrument the personf s), or the entity upon behalf of
which the persons} acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
Signagre of Notary Public
KIRSTEN SQUARCIA
t Notary Public - California Z
Santa Clara County f
° Commission # 2431589
'r`•c My Comm. Expires Dec 19, 2026
(Notary Seal) e
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
(Title or description of attached document)
(Title or description of attached document continued)
Number of Pages Document Date
(Additional information)
CAPACITY CLAIMED BY THE SIGNER
❑ Individual (s)
❑ Corporate Officer
(Title)
❑ Partner(s)
❑ Attorney -in -Fact
❑ Trustee(s)
❑ Other
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as
appears above in the notary section or a separate acknowledgment form must be
properly completed and attached to that document. The only exception is if a
document is to be recorded outside of California. In such instances, any alternative
acknowledgment verbiage as may be printed on such a document so long as the
verbiage does not require the notary to do something that is illegal for a notary in
California (i.e. certifying the authorized capacity of the signer). Please check the
document carefidly for proper notarial wording and attach this form if required.
• State and County information must be the State and County where the document
signer(s) personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s) personally appeared which
must also be the same date the acknowledgment is completed.
• The notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title (notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
notarization.
• Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.
lre/shel4w3 ,- is /are ) or circling the correct forms. Failure to correctly indicate this
information may lead to rejection of document recording.
• The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges, re -seal if a
sufficient area permits, otherwise complete a different acknowledgment form.
• Signature of the notary public must match the signature on file with the office of
the county clerk
Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
Indicate title or type of attached document, number of pages and date.
indicate the capacity claimed by the signer. If the clai ned capacity is a
corporate officer, indicate the title (i.e. CEO, CFO, Secretary).
• Securely attach this document to the signed document
C 2004-2015 ProLink Signing Service, Inc. — All Rights Reserved wnvw.TheProLink.com — Nationwide Notary Service