Sec. 10-108 Acknowledgment Certificate.

State of Indiana   )

            )   SS:

County of Lake   )

   Before me, the undersigned Notary Public in and for the County and State, personally appeared                       (owner) and each separately and severally acknowledged the execution of the foregoing instrument as his or her voluntary act and deed, for the purposes expressed therein.

      WITNESS my hand and Notarial Seal this       day of                    , 19   .

                                 Notary Public

   SEAL

   My Commission Expires                      , 19   . (Ord. No. 791, Title XIV, § 4, 6-8-71)