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, , Executed this at Signature: I certify under PENALTY OF PERJURY under foregoing paragraph is true and correct. WITNESS my hand and official seal. “A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.” ) State of California County of ) On before me, personally appeared who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. Place Notary Seal Above Owner or Designated Agent's Declaration Under Penalty of Perjury California. All-Capacity Notary Acknowledgment ANNUAL MOBILEHOME PARK - REGISTRATION YEAR: Community Name: PLEASE NOTE SIGNATORY REQUIREMENT PURSUANT TO CITY OF PALMDALE ORDINANCE NO. 1662: All registration forms, and any documentation accompanying any registration forms, shall contain an affidavit or declaration, signed by the owner or a designated agent, with his/her signature notarized (All- Capacity Notary Acknowledgement provided below), certifying that the information contained herein is true, correct, and complete. PLEASE NOTE: A designated agent shall either be a principal in a licensed property management company, which is contractually bound to operate and manage the Mobilehome Park, or an individual (NOT AN ON-SITE MANAGER), who is employed by a property owner for the sole purpose of operating the mobilehome park business. I, declare under penalty of perjury under the laws of the State of California that the information contained in the current year Annual Mobile Home Park registration is true, correct and complete. I further declare I have a contractual arrangement that gives me authority to operate and manage all aspects of the Mobile Home Park's business. day of Page 2