Power Of Attorney For Corporation Form Page 2

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STATE OF ______________________________________
COUNTY OF ____________________________________
On this day of _______________ A.D., 20 ________ before me, the subscriber, a Notary Public,
duly appointed to take the proof and acknowledgment of deeds and other instruments, came
___________________________ President, and __________________________, Secretary of the
______________________________________ Corporation to me personally known to be the individuals
described in and who executed the preceding instrument; and they each duly acknowledged the execution of
the same; and being by me each sworn, severally and each for himself deposeth and saith, that they are the
said officers of the _________________________________ Corporation aforesaid, and that the seal affixed
to the preceding instrument is the corporate seal of said Corporation; and that said corporate seal and their
signatures as such officers were duly affixed and subscribed to the said instrument by the authority and
direction of said corporation.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my official seal, at the
City of ___________________________ the day and date first above written.
_____________________________________________________________________________
_____________________________________________________________________________
Official Title
My Commission Expires:
___________________________________________

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