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Page 2 of 2 Minnesota Uniform Conveyancing Blanks Form 10.3.5 <br /> <br /> <br />State of Minnesota, County of <br /> <br />This instrument was acknowledged before me on , by <br /> (month/day/year) (name of authorized signer) <br /> as <br /> (type of authority) <br />and by <br />(name of authorized signer) <br />as of . <br /> (type of authority) (name of Grantor) <br /> <br /> <br />(Stamp) <br /> <br />(signature of notarial officer) <br /> Title (and Rank): <br /> <br />My commission expires: <br /> (month/day/year) <br /> <br /> <br />THIS INSTRUMENT WAS DRAFTED BY: <br />(insert name and address) <br /> TAX STATEMENTS FOR THE REAL PROPERTY DESCRIBED IN THIS <br />INSTRUMENT SHOULD BE SENT TO: <br />(insert legal name and residential or business address of Grantee) <br />