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ST. FRANCIS MANOR OF VERO BEACH, <br />FLORIDA, INC. <br />Anthony Dzielski, President <br />Witness: <br />Printed Name: <br />Date <br />STATE OF FLORIDA <br />COUNTY OF INDIAN RIVER <br />Witness: <br />Printed Name: <br />Date <br />The foregoing was acknowledged before me this day of , 2016, by Anthony <br />Dzielski, President of ST. FRANCIS MANOR OF VERO BEACH, FLORIDA, INC., a <br />Florida non-profit corporation, on behalf of said corporation. <br />NOTARY PUBIC: <br />Signature of Notary Public - State of Florida <br />Stamped Commissioned Name of Notary <br />Public with Commission Expiration Date and <br />Seal: <br />Personally Known OR Produced <br />Identification <br />Type of Identification Produced <br />4 <br />141 <br />