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THIS POitli IS D~ ~'T~T <br /> Ate IPOYEHw'rrvc' <br /> PROVIDER'S ACKNOWLEDG~IEYT <br /> State of ) <br /> SS. <br /> County of ) <br /> On this day of , befo me penanally <br /> appeared , to me persaaally tm who being by me <br /> duly sworn, did say that he/she v the of <br /> .the PROVIDER named in the fore ia; instrument, aad that <br /> he/she is authorized to siga said itutrumeat on behalf of the OVIDER, u provided in <br /> Recital E of tha foregoin= Agreemeat, aad aclmowie es that he/she executed said <br /> <br /> instrument as the free act and deed of rite PROVIDE <br /> ~ tary Public <br /> .caarmitsion esgizex <br /> EXEII~T TRAN3ACriON3 Fars AG3Fssa~l~"~ <br /> Pave 6 <br /> <br />