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DEPARTMENT OF LIQUOR CONTROL COUNTY OF HAWAI‘I <br />Hilo Lagoon Centre, 101 Aupuni St., Unit 230, Hilo, Hawai‘i 96720 * Phone: (808)961-8218 * Fax: (808)961-8684 <br />E-Mail: cohdlc@co.hawaii.hi.us <br />STATE OF HAWAI‘I) <br />) SS. <br />COUNTY OF HAWAI‘I ) <br />On ___________________, before me personally appeared __________________ to me <br />known to be the person described in and who executed the foregoing instrument, and acknowledged that the <br />person executed the same as the person’s free act and deed. <br /> <br /> Notary Public, State of Hawai‘i <br /> Printed Name: ________________ <br /> My commission expires: _________ <br />NOTARY CERTIFICATION STATEMENT <br />Document Identification or Description: <br />. <br />Doc. Date: ________________or Undated at time of notarization. <br />No. of Pages: ______________ Jurisdiction: Third Circuit <br />_______________________________________________________ <br />Signature of Notary Date of Notarization and <br />Certification Statement <br />______________________ <br />Printed Name of Notary <br />Hawai‘i County is an Equal Opportunity Provider and Employer <br />