Pennsylvania Limited Power Of Attorney Form (Page 6 of 6) in pdf

Pennsylvania Limited Power Of Attorney Form Page 6

Notary Acknowledgement (Must be completed by Notary)

State of ___________ County of ______________________________ Subscribed,

Sworn and acknowledged before me by ______________________________, the

Principal, and subscribed and sworn to before me by ______________________,

witness, this ______________________ day of ________________________.

______________________________

Notary Signature

Notary Public

In and for the County of ______________________________

State of ______________________________

My commission expires: ______________________________ Seal

Acknowledgement and Acceptance of Appointment as Attorney-in-Fact

I, ______________________________ have read the attached power of attorney

Name of Attorney-in-Fact

and am the person identified as the attorney-in-fact for the principal. I hereby

acknowledge that accept my appointment as Attorney-in-Fact and that when I

act as agent I shall exercise the powers for the benefit of the principal; I shall

keep the assets of the principal separate from my assets; I shall exercise

reasonable caution and prudence; and I shall keep a full and accurate of all

actions, receipts and disbursements on behalf of the principal.

______________________________ ______________________________

Signature of Attorney-in-Fact

Date

Acceptance of Appointment as successor Attorney-in-Fact

I, ______________________________ have read the attached power of

Name of successor Attorney-in-Fact

attorney and am the person identified as the successor attorney-in-fact for the

principal. I hereby acknowledge that I accept my appointment as Successor

Attorney-in-Fact and that, in the absence of a specific provision to the contrary

in the power of attorney, when I act as agent I shall exercise the powers for

the benefit of the principal; I shall keep the assets of the principal separate

from my assets; I shall exercise reasonable caution and prudence; and I shall

keep a full and accurate record of all actions, receipts, and disbursements on

behalf of the principal.

______________________________ ______________________________

Signature of Successor Attorney-in-Fact

Date

Pennsylvania Limited Power Of Attorney Form Page 6