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<br /> <br /> <br /> <br /> <br /> , <br />a <br />«BorrowerName» <br /> <br /> <br />By: <br /> <br />Title: <br /> <br />Dated: <br /> <br /> <br />By <br /> <br />Title: <br /> <br />Dated: <br /> <br /> <br /> <br /> <br /> <br />STATE OF MINNESOTA ) <br /> ) ss. <br />COUNTY OF ) <br /> <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 /> <br /> <br /> <br /> Notary Public <br /> <br />This Declaration was drafted by: <br />[insert name and address] <br />Minnesota Public Facilities Authority 2020 Special Appropriation Forms <br />19 of 28 October 2020