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IN WITNESS WHEREOF, the said Owner(s) have hereto set their hand(s) <br /> and seal(s) this day of , 19 <br /> (Seal) <br /> (Seal) <br /> ACCEPTED FOR THE COUNTY OF DANE: <br /> Carol N. Little, COUNTY CLERK <br /> ACCEPTED FOR THE TOWN OF : <br /> , TOWN CLERK <br /> Signatures of <br /> and Carol N. Little authenticated <br /> this day of , 19 <br /> (Seal) <br /> Title: Member State Barr of Wisconsin <br /> or other Party Authorized under s. <br /> 706.06 viz. <br /> STATE OF WISCONSIN) <br /> ) ss. <br /> DANE COUNTY ) <br /> Personally came before me this day of , 19 , <br /> the above-named <br /> and Carol N. Little to me known to be the person(s) <br /> who executed the foregoing instrument and acknowledged the same. <br /> Notary Public, County, Wisconsin. <br /> My Commission expires <br /> This instrument drafted by: <br /> Names of persons signing in any capacity must <br /> be typed or printed below their signatures. <br /> 2902:aa012185:CWK:c <br /> • <br />