Resolved that a dividend is hereby declared out of the capital surplus of the corperation to be payable to the stockholders of the corperation in the amount of $ ( fill in blank) per share. Such dividend shall be payable on the ( fill in the blank day of ( fill in the Blank, fill in the blank,) in cash to the shareholders on the ( fill in the blank), day of fill in the blank. the treasurer of the corporation is hereby authorized to set aside the sum necessary to pay said dividends.

My question is: Where it shows dates that need to be filled in how am I suppose to write out that date? So let's say we use September 16th 2022 how would I write that out based on the format given above?