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IA_10.12.2018
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IA_10.12.2018
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Last modified
10/15/2018 8:13:07 AM
Creation date
10/15/2018 8:12:08 AM
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Template:
Recorded Docs
Recorded Docs - Type
Agreement
Subject
Kaiser Permanente Hospitals
Rec Date
10/12/2018
Parties
Kaiser Permanente Hospitals
MO Ref
18-182
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE <br />aS ��.aGC�Gata .w�.a<.a .a<.a .m .a< aL wt �Lf��LaLaL.aCaCaL/a"a<,al ACai�c.�.ad Tvovc� ,a .a .aS.a�f</.�<C�S.a . <br />A notary public or other officer completing this certificate verifies only the identity of the individual who signed the <br />document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. <br />State of California <br />County of IAL M ED> l ) Pd A— - <br />On Slid % /f3 before me, 1—.VN/J <br />Date Here Insert Name and Title of the Officer <br />personally appeared ✓%AGE (C -2—o 2'a 2 i c 17 <br />Namely) of Signer& <br />who proved to me on the basis of satisfactory evidence to be the person( &) whose name($) is/are- <br />subscribed to the within instrument and acknowledged to me that he /sheMiey executed the same in <br />his/herltbear authorized capacity(les), and that by his/hen*irsir signature( on the instrument the person(§), <br />or the entity upon behalf of which the person(N acted, executed the instrument. <br />I certify under PENALTY OF PERJURY under the laws <br />of the State of California that the foregoing paragraph <br />LYNN M. TILTON <br />is true and correct. <br />r :• Commission # 2109702 WITNESS my hand and official seal. <br />s; ®" Notary Public - California <br />Alameda County <br />My Comm. Ex fires May 26,20) Signature <br />Signature of Notary Public <br />LYNN M. TILTON <br />Commission 2109702 <br />i :-d Notary PubIIL - California zZ <br />z Alameda County <br />My Comm. Expires May 26, 2019 <br />Place ArolaTy Seal Above <br />OPTIONAL <br />Though this section is optional, completing this information can deter alteration of the document or <br />fraudulent reattachment of this form to an unintended document. <br />Description of Attached Document <br />Title or Type of Document: Document Date: <br />Number of Pages: Signer(s) Other Than Named Above: <br />Capacity(ies) Claimed by Signer(s) <br />Signer's Name: <br />❑ Corporate Officer — Title(s): <br />❑ Partner — ❑ Limited ❑ General <br />❑ Individual ❑ Attorney in Fact <br />❑ Trustee ❑ Guardian or Conservator <br />❑ Other: <br />Signer Is Representing: <br />Signer's Name: <br />❑ Corporate Officer — Title(s): <br />❑ Partner — ❑ Limited ❑ General <br />❑ Individual ❑ Attorney in Fact <br />❑ Trustee ❑ Guardian or Conservator <br />❑ Other: <br />Signer Is Representing: <br />©2014 National Notary Association • www.NationalNotary.org • 1- 800 -US NOTARY (1- 800 - 876 -6827) Item #5907 <br />
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