Fsa-211, 2005, Power Of Attorney Page 2

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Form Approved - OMB No. 0560-0190

FSA-211A

U.S. DEPARTMENT OF AGRICULTURE

Attachment Pages

(07-26-05)

Farm Service Agency - Commodity Credit Corporation - Federal Crop Insurance Corporation

POWER OF ATTORNEY SIGNATURE CONTINUATION SHEET

Attach to Form FSA-211

NOTE:

The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting the following

information is The Food Security and Rural Investment Act of 2002 (Pub. L. 107-171) and 7 CFR Part 718. The information will be used to legally document your opinion to appointing an

attorney-in-fact, identify the person and authorities granted to the appointee. Furnishing the requested information is voluntary; however, failure to furnish the requested information will result in the

individual or entity not be able to act as your attorney-in-fact. This information may be provided to other agencies, IRS, Department of Justice, or other State and Federal Law enforcement agencies,

and in response to a court magistrate or administrative tribunal. The provisions of criminal and civil fraud statutes, including 18 USC 286, 287, 371, 651, 1001; 15 USC 714m; and 31 USC 3729, may

be applicable to the information provided.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control

number. The valid OMB control number for this information collection is 0560-0190. The time required to complete this information collection is estimated to average 15 minutes per response,

including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. RETURN THIS

COMPLETED FORM TO YOUR COUNTY FSA OFFICE.

1. Name of Attorney-In-Fact (Item (1) from FSA-211)

2. Name of Grantor (Item (5) from FSA-211)

AUTHORIZED SIGNATURES

3B. Date

3C. Social Security

3A. Signature of Grantor

(MM-DD-YYYY)

Number

3D. Witness Signature (FSA Employee Only)

3E. Date

3F. Official Position

(MM-DD-YYYY)

3G. Notary Public (this form shall be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature: _______________________________

County of

State of

4B. Date

4C. Social Security

4A. Signature of Grantor

(MM-DD-YYYY)

Number

4D. Witness Signature (FSA Employee Only)

4E. Date

4F. Official Position

(MM-DD-YYYY)

4G. Notary Public (this form shall be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature: _______________________________

County of

State of

5B. Date

5A. Signature of Grantor

(MM-DD-YYYY)

5C. Social Security

Number

5E. Date

5F. Official Position

5D. Witness Signature (FSA Employee Only)

(MM-DD-YYYY)

5G. Notary Public (this form shall be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

County of

Signature: _______________________________

State of

6A. Signature of Grantor

6B. Date

6C. Social Security

(MM-DD-YYYY)

Number

6F. Official Position

6D. Witness Signature (FSA Employee Only)

6E. Date

(MM-DD-YYYY)

6G. Notary Public (this form shall be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

County of

Signature: _______________________________

State of

7A. Signature of Grantor

7B. Date

7C. Social Security

(MM-DD-YYYY)

Number

7D. Witness Signature (FSA Employee Only)

7E. Date

7F. Official Position

(MM-DD-YYYY)

7G. Notary Public (this form shall be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

County of

State of

Signature: _______________________________

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable,

sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's income is derived

from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program

information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA,

Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal

opportunity provider and employer.