ML19121A268

Sacramento Municipal Utility District (Smud) - California All Purpose Acknowledgment Affirmation Pursuant to 10 CFR 72.16(b)

ML19121A268
Person / Time
Site:	07200011
Issue date:	04/17/2019
From:	Sacramento Municipal Utility District (SMUD)
To:	Office of Nuclear Material Safety and Safeguards
References
DPG-19-042, CAC 001028, CAC 000993, EPID L-2018-LNE-0004, EPID L-2018-RNW-0005
Download: ML19121A268 (2)

Text

Enclosure 6 to DPG-19-042 California All Purpose Acknowledgment of SMUD Affirmation Pursuant to 10 CFR 72.16(b)

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l 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 I which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.

State of California County of SACRAMENTO On_l/+-/t_7 !_/Cf~ before me, _J_O_S_E_P_H_M_A_I_T_A _____________, Notary Public, (Here insert name and title of the officer) personally appeared --~LJ

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L_L_ M_ 4_ /\\J 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.

(Notary Seal 1***********

• 1 JOSEPH MAITA Notary Public - California 2

Sacramento County

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Commission# 2228827 My Comm. Ex;iires Feb 14. 2022 ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Tirle or description of attached document)

(Title or description of attached document continued)

Number of Pages __ Document Date ____ _

(Additional information)

CAPACITY 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 ackn01vledgme111 completed in California must contain verbiage exactly as appears above in the nota,y section or a separate acknowledgment form must be properly completed and al/ached to that document. The only exception is if a document is to be recorded outside of California. In such instances. any alternative ackno1vledgme111 l'erbiage as may be printed on such a documem so long as the verbiage does nor require the nota,y ro do something that is illegal for a notary in California (i.e. certifying the awhori=ed capacity of the signer). Please check the docume111 carefullyfor 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.

he/she/tl,ey,- is lafe) 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 ottice 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 2004-20 IS Pro Link Signing Service, lnc. - All Right~ Re.~erved v."\\vw.TheProLink.cnm - Nation\\\\ide Notary Ser.;ce