Special Power Of Attorney Form Page 2
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2IN WITNESS WHEREOF, I have hereunto set my hand and seal this ______ day of
____________________, ________.
____________________________________
Signature
STATE OF _____________________________
)
)
CITY/COUNTY OF _______________________ )
On this ______ day of ____________________. ________, before me,
____________________________________, and who is known to me to be the person whose
name is subscribed to the within Special Power-of-Attorney and acknowledged that he/she
executed the same for the purposes therein contained, as his free act and deed.
Sworn to and subscribed before me this ______ day of ____________________,
________.
______________________________
Notary
My Commission Expires:
(NOTE: Have this form notarized, if possible, otherwise have the form witnessed)
______________________________
Witness
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