affiant exhibiting his ____________________________________________________ issued on ____________ ____ ___________, ___, in _____________ ______ _______________ __________, __, known known to me me to be the the same person perso n who who executed the foregoing foreg oing instrument, instrument, and they they acknowl ack nowledge edged d to me that that the same sa me is their their free and volun voluntary tary act and deed. d eed.