Signature Page
SEAL
Developer _________________________
(Name of Organization)
By: ______________________________
Print Name: ________________________
Title: _____________________________
Attested
By: ______________________________
Print Name: ________________________
Title: _____________________________
SEAL
City of Winston-Salem (via Stormwater
Department of the City of Winston-Salem)
By: ______________________________
Print Name: Keith Huff________________
Title: Stormwater Director_____________
Attested
By: ______________________________
Renee L. Phillips
City Secretary
This instrument has been preaudited in the manner
required by the Local Government and Fiscal
Control Act.
Approved as to form and legality.
This ____ day of _________, 2011.
This ____ day of _________, 2011.
____Not Applicable________________________
By Lisa Saunders, Assistant Financial Officer
__________________________________
By Angela I. Carmon, City Attorney
STATE OF NORTH CAROLINA
COUNTY OF FORSYTH
)
)
)
I, ________________, a notary public of the County and State aforesaid, certify
that ____________________, personally came before me this day and acknowledged that
he is the _____________of, ____________________ and that by authority duly given
Title of person
the Name of Organization
and as the act of the corporation, the foregoing instrument was signed in its name by its
__________________.
Witness my hand and notarial
______________________, A.D., 2011.
seal,
this
the
__________
________________________
Notary Public
My commission expires: __________________
day
of