THE GRANTOR, _______________________________, City
of_____________, State of _________ for the consideration
($______________) CONVEY and QUITCLAIM
of_____________________County of ______________
State of ____________, all interest in the following
described real estate situated in the County of
Portage, in the State of Ohio, to wit: See Exhibit A attached.
Dated this ____________day of (mo.) ________________, (yr.)
STATE OF OHIO, COUNTY OF PORTAGE
I, _____________________________________, Notary Public in and
for the state of Ohio, do hereby certify
that on this_________day of (mo.) ____________________,
________________________ personally appeared before me (or
proved to me on the basis of satisfactory evidence) to be the
individual described in and who executed the within instrument and
acknowledged that he signed the same as his free and voluntary act
and deed for the uses and purposes herein mentioned.
Given under my hand and official seal this ____________day of
(mo.)______________________, (yr.) _________________.
My commission expires (mo./day) _______________________________,