IN WITNESS WHEREOF, I ________________________, hereunto set and
subscribed my hand and signature at ______ this ____ day of _________,
_____.
SIGNED AND DELIVERED by
)
the withinnamed
)
_________________________
) _____________________
in the presence of .................
)
EXPLAINED AND IDENTIFIED BY ME
____________________________
___________________________
Specimen signature of Attorney
( ____________________ )
BEFORE ME