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, a <br />«BorrowerName» <br />By: <br />Title: <br />Dated: <br />By <br />Title: <br />Dated: <br />STATE OF MINNESOTA ) <br />) ss. <br />COUNTY OF ) <br />This forgoing instrument was acknowledged before me this ___ day of ___________, 20__, by <br />_________________________the _________________[insert name and title of first signatory], and <br />__________________, the ________________________[insert name ant title of second signatory], <br />respectively, of the_____________________, a _______________________, [insert name and description of <br />the entity receiving the funds]. <br />Notary Public <br />This Declaration was drafted by: <br />[insert name and address]