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. OPTIO~IAL FORM 175
. . ,(FORMERLV FS-sa)
MARCH 1975
' DEPT. OF STATE
S017S-30~
C'ertificate of Acknowledgment of Execution of an Instrument
Republic of the Philippines
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(Country)
City of Manila
~ (County and/or other politicai diri~ion) ~
flnbassy of the United STates ~:
~ (Countr and/or other political divi~ion)
of America
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(Namc oi forcip~ ~enice ottice)
i . Alma J. Engel Vice Consul
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' Manila, Phili~ipines
'; of the United States ojAmerica at
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19
{ duJy commissioned and qualified, do hereby certijy that on th:s
January, 1981
day of , bejo~e me pe~sonal/y oppeared ________
(DATEJ
**Martha R. Horrigan**
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E to me pe~sonally known, and known to me to be the individual described in, whose
~ is
~ nume~_____subscribed to, and who executed the annexed instrument, and being
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~ injormed by me oj the cofitents ojsaid ins~rument she duly acknowledged to n:e
~ rhQf she ~xecuted the same jree/y and voluntarily for the uses and purposes therein
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~ mentioned_ (9SI F~:S 24 ~" 3' I S
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~ ~~ ' ~ . . CLEn^Y, C~. ,. ,' -'` ~
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; "~~ ;`~ :; ~~ i'~ /ir witness whereojl have hereunto set my hand and
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~ ~; ~ ^ ; .(SEAI,~;~4. ~ .
~ - ;.~t:~,,. ,1 .~ f,~ ojrcia! seal the day and yea~ last above written.
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Alma J. Engel
Vice Consul
_ oj the United Swtes oj America
~~ x349 P~GE 4~9 --"- ~
NOTE.-Wherevei prscticabk all si6natura to a docvment ~bouW be inctuded in one certificate.
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