Illinois Administrative Code
Title 35 - ENVIRONMENTAL PROTECTION
Part 811 - STANDARDS FOR NEW SOLID WASTE LANDFILLS
Subpart G - FINANCIAL ASSURANCE
Appendix A - Financial Assurance Forms
ILLUSTRATION B - Certificate of Acknowledgment

CERTIFICATE OF ACKNOWLEDGMENT

State of __________________________)

) SS

County of _________________________)

On this _________ day of ________, __________ before me personally came _______________________________ (operator) to me known, who, being by me duly sworn, did depose and say that she/he resides at ______________________________________ (address), that she/he is ____________________________________________ (title) of __________________ (corporation), the corporation described in and ________________________________________________________________________________ which executed the above instrument; that she/he knows the seal of said corporation; that the seal affixed to such instrument is such corporate seal; that it was so affixed by order of the Board of Directors of said corporation, and that she/he signed her/his name thereto by like order.

___________________________________ Notary Public

My Commission Expires ________________