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SJR-273913v1 <br />MU205-30 <br /> <br />5 <br /> <br /> MEDTRONIC, Inc., a Minnesota <br /> corporation <br /> <br /> <br /> <br /> By _________________________ <br /> Its ___________________ <br /> <br /> <br /> <br /> <br /> <br /> <br />STATE OF MINNESOTA ) <br /> ) ss. <br />COUNTY OF ) <br /> <br /> On this ________ day of January, 2006, before me, a notary public within and for <br />___________ County, personally appeared ____________________ , to me personally known who <br />by me duly sworn, did say that ___ is the ______________________ of Medtronic, Inc., a <br />Minnesota corporation for and on behalf of said corporation . <br /> <br /> <br /> <br /> <br /> _________________________ <br /> Notary Public <br />