Fillable Form Spoa Special - Special Power Of Attorney (Page 4 of 4) in pdf

SPECIAL POWER OF ATTORNEY

MILITARY ACKNOWLEDGMENT

With the United States Armed Forces

On this the _______ day of _____________________________, 20____, before the undersigned

officer, personally appeared _____________________________________________________________,

satisfactorily proven to be (a) serving in or retired from the Armed Forces of the United States, or (b) a

lawful dependent of a person serving in or retired from the Armed Forces of the United States, or (c) a person

serving with, employed by, or accompanying the Armed Forces of the United States outside the United

States and outside the Canal Zone, Puerto Rico, Guam, and the Virgin Islands, and to be the person whose

name is subscribed to the within instrument and acknowledged that he or she executed the same. And the

undersigned does further certify that he or she is at the date of this certificate an officer of the Armed Forces

of the United States having the general powers of a notary public under the provisions of Section 936 or

1044a of Title 10 of the United States Code (Public Law 90-632 and 101-510).

AUTHORIZED TO ACT AS A NOTARY

_____________________________________________

PUBLIC UNDER THE PROVISIONS OF

Signature of Notary

SECTION 1044a OF TITLE 10 OF THE

Name of Officer and Position:

UNITED STATES CODE AND SECTION

Grade and Branch of Service:

1183.5 OF THE CALIFORNIA CIVIL

Command or Organization:

CODE. NO SEAL REQUIRED BY LAW.

Either a Military or Civilian Acknowledgment is Required

CIVILIAN ACKNOWLEDGMENT

State of California

)

County of San Bernardino

) ss.

Marine Corps Air Ground Combat Center

)

On _______________________, before me,____________________________________________________,

personally appeared _______________________________________________________________________,

who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within

instrument and acknowledged to me that he/she executed the same in his/her authorized capacity, and that by

his/her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the

instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is

true and correct.

WITNESS my hand and official seal.

Signature _______________________________

Seal

Page 4 of 4

SPOA SPECIAL 3-18-11

________

Initials

Form Spoa Special - Special Power Of Attorney Page 4

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