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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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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 § 1189 <br />A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document <br />to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. <br />State of California <br />County of Scvl h' A-� <br />Ont✓COy0L� s(oZO(e before me, <br />Date Here Insert Name and Title of the Officer <br />personally appeared <br />Name(sy6f Signer(sy <br />who proved to me on the basis of satisfactory evidence to be the personwwhose name4ojs /are- subscribed <br />to the within instrument and acknowledged to me that IJErshe /;key executed the same in qi her /geir- <br />authorized capacitylJes) -and that by W<her /tbeirsignature(sron the instrument the person(s},-or the entity <br />upon behalf of which the person(sYacted, executed the instrument. <br />JULIE MA ROSAS <br />Commission # 2111078 <br />Notary Public - California zf <br />San Mateo County <br />Comm. Ares Ma 11, 2019 <br />Place Notary Sea/ and /or Stamp Above <br />I certify under PENALTY OF PERJURY under the <br />laws of the State of California that the foregoing <br />paragraph is true and correct. <br />WITNESS my hand and official seal. <br />Signature <br />Signature of Notary Public <br />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: pl'�G1rY�/t �— �)r ICGtt�t! IMl32 <br />Document Date: i��kt� er- 4t?ota NumberofPages:. <br />Signer(s) Other Than Named Above: 01A <br />Cap city(ies) Claimed by Signers) <br />Signer me: <br />❑ Corporate er — Title(s): <br />❑ Partner — ❑ Limn General <br />• In ividual C may in Fact <br />• Trustee ❑ Guardian of Conservator <br />❑ Other: <br />Signer is Representing: <br />02017 National Notary Association <br />Signer' Name: <br />❑ Corpora icer — Title(s): <br />❑ Partner — ❑ Li ❑General <br />❑ Individual ❑ ey in Fact <br />• Trustee ❑Guardian onservator <br />• Other: <br />Signer is Representing: <br />
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