"STATE OF LOUISIANA
PARISH OF____________
_____________, Louisiana
______________________
(DATE)
I, ______________________ do hereby certify that this document is a true and correct copy of the original thereof, consisting of _____ page(s), being a reproduction thereof from the records on file with the undersigned, in accordance with Louisiana Revised Statutes, Title 13, Section 3733.
_______________________
NAME:
TITLE:
ADDRESS:"
La. R.S. § 13:3733