ML19204A251

Enclosure 8 to DPG-19-087 - CA Acknowledgment of Smud Affirmation

ML19204A251
Person / Time
Site:	07200011
Issue date:	07/01/2019
From:	Tallman D Sacramento County, CA, Sacramento Municipal Utility District (SMUD)
To:	Office of Nuclear Material Safety and Safeguards
Shared Package
ML19204A239	List: ML19204A244 ML19204A251
References
CAC 000993, CAC 001028, DPG 19-087, EPID: L-2018-LNE-0004, EPID: L-2018-RNW-0005
Download: ML19204A251 (2)

Text

Enclosure 8 to DPG-19-087 California All Purpose Acknowledgment of SMUD Affirmation Pursuant to 10 CFR 72.16(b)

CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 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

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On 7) t l \\'i before me, ~~-

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Date Heretns~'Vame and Title of the Offic<6' personally appeared ---~----A---~~f,l...,_l~lt'V\\An

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Name(sJ of Signer(s) 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.

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• f Notary Public - California 2

if Sacramento County S::

Commission# 2188409 My Comm. Expires Mar 26, 2021 Place Notary Sea/ Above I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

---

OPTTONAL----------------

Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document.

Description of Attached Document Title or Type of Document: ____________________________ _

Document Date: ___________________ Number of Pages: _____ _

Signer(s) Other Than Named Above: _______________________ _

Capacity(ies) Claimed by Signer(s)

Signer's Name: ____________ _

Signer's Name: ____________ _

Corporate Officer -

Title(s): ______ _

Corporate Officer -

Title(s): ______ _

Partner -

Limited General Partner -

Limited General Individual Attorney in Fact Individual Attorney in Fact Trustee Guardian or Conservator Trustee Guardian or Conservator Other: _____________ _

Other: _____________ _

Signer Is Representing: _________ _

Signer Is Representing: _________ _

©2016 National Notary Association* www.NationalNotary.org

• 1-800-US NOTARY (1 -800-876-6827)

Item #5907