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• OPTIONAL FORM 173 ~ ~ ~'~•!f
~ (FORMERLY FS•8!)
• MARCH 1973
DEPT. OF STATE
5017'3-301
Certificate of Acknowledgment of Execution of an Instrument
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DOI[INICAN RSPIIBLI_C
(country) _
NATION_A_L_ _DI_3_T_RICT
(COYnty andior Otblt pOlitkal dividoa) _
CITYOccF 3ANTL0 D01[INGO D$ GUZYAN
81[BA33Y A~F
TEiB ~ I T8D
3T~ Ta3 OF
Al[SRIC_A_
(xame
or rorelp~ .or.iee otria)
1,_ Dale L. Shtl~~4~ ~
~99~1
' of the United States of America at Santo Do'ingo~_Dominican Republic
duly commissioned and qualified, do hereby certify that on this 28th _
day of November. 1979 , before me personally appeared Guillermo Solomon
lversl
to me personally known, and known to me to be the individual-described in, whose
~ name~~8__subscribed to, and who executed the annexed instrument, and being
informed by me of the contents of said instrument._b.~_duly acknowledged to me
that,;~_.executed the same freely and voluntarily for the uses and purposes therein
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j _.rwaMiovted.
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~ N. ' . /s,.~/• • 1» witness whereojl have hereunto set my hand and
~y # t ~ official seal the day and year last above written.
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y' • - Dale L. ha f fer
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gp(~e~~ PAGE~.VcJ1 C4AI931h__ ojthe United State ojMtuica . ~