Limited Power Of Attorney And Tax Information Authorization Form (Page 2 of 2) in pdf

Limited Power Of Attorney And Tax Information Authorization Form Page 2

ATTESTATION OF AGENT

I, _____________________________________ do hereby attest that I accept appointment as agent for

_______________________________________ (hereafter "principal") and:

that I understand my duties under this Limited Power of Attorney and under the law;

that I understand that I have a duty for the principal as to the specific transactions and types of transactions if

expressly required to do so in this Limited Power of Attorney;

that I hereby specifically acknowledge and accept such duties to act in signing this Limited Power of Attorney;

in the case of such a duty to act, my agreement to act on or behalf of the principal is enforceable against me

regardless of whether there is any consideration to support a contractual obligation;

that I understand and acknowledge in signing this Limited Power of Attorney, that if I have been selected as agent

with the expectation that I have special skills or expertise I will use those skills on behalf of the principal.

_____________________________________________

_____________________________

Signature of Agent

Date Signed

Limited Power Of Attorney And Tax Information Authorization Form Page 2