(Referred from LMC 15.10.260(B))

STATE OF WASHINGTON	)
	)s
COUNTY OF THURSTON	)

This is to certify that on this __________ day of _______________, 20 ____, before me, the undersigned, a Notary Public, personally appeared ____________________, to me known to be the person who executed the foregoing dedication and acknowledged to me that ____________________ signed and sealed the same as _______________ free and voluntary act and deed for the uses and purposes therein mentioned.

Witness my hand and official seal the day and year first above-written.

	___________________________________
	NOTARY PUBLIC in and for
(S E A L)	the State of Washington,
	residing at ____________________
	My commission expires:
	___________________________________