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~ ~ ~_:1PTIONAL FORM 17S
(FORMERLV FS-~S)
MARCN 19~5
, OEPT. OF STATE ~
S017S-101
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Ce~rtificate of Acknowledgment of Execution of an- Instnunent :
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Rep~ublic of Pbrtu~sl-------~~_____ ~ -
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(Counttr) - ,,F E POtTR~s
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(County.sadJor othu polltkal dh~ion) JU4 ~ f
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. ~ ~',R~gy,~t~ of thg_tl~ii~gd Stetes~ :
(CouatY aed/or other politkal dlvi~ion)
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~ of the United States ojAmesica at Oporto, pbrtu,~?1 _ ~~_M -
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duly commissioned and qualified, do he~eby certify that on this ~d
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' day of _June. 1978 before me personally appeared _Assis Sim~es Aires
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~ and Isaura Martins Aires
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to me personally known, and known to me to be the individua!-$described i», whose
name~h~3C_subscribed to, and who executed the annexed instrument, and being
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injormed by me ojthe contents of said instrument_~_duly acknowledged to me ~
that~h~3L.executed the same jreely and vol.untarily for the uses and purposes therein
mentioired. ~
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~ !~i wih:ess whe~eojl l:ave he~eunto set rny hand and
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~ ftcial seal the d nd year last above written.
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~~_CflltAlll__ oj he United Smtes oj Ameiinc
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TiOTE.-Whererer practiabb sll sianatures to a ment ~houW be ioctuded in one certif'~te. ~ `
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