Power Of Attorney Form (Page 3 of 4) in pdf

Power Of Attorney Form Page 3

ORPORATE

ERTIFICATION

I, [13]

certify that I am the [14]

[15]

organized under the laws of the State of [16]

and

that [17]

who signed this Power of Attorney on behalf of the grantor is the [18]

of said corporation; and that said Power of Attorney was duly signed, attested for and on

behalf of said corporation by authority of its governing body as the same appears in a resolution of the Board of Directors

passed at a regular meeting held on the[19]

day of

now in my possession or

custody. I further certify that the resolution is in accordance with the Articles of Incorporation and Bylaws of said corporation.

IN WITNESS WHEREOF, I have hereunto set my hand at the City of [20]

, this

[21]

day of

[22]___________________________________

[23]

(Signature)

(Date)

NDIVIDUAL OR

ARTNERSHIP

ERTIFICATION

City: [24]

County: [25]

State: [26]

SS# [27]

On this [28]

day of

personally appeared before me

[29]

residing at [30]

personally known

or sufficiently identified to me, who certifies that [31]

(is) (are) the

individual(s) who executed the foregoing instrument and acknowledge it to be [32]

free act and deed.

[33]____________________________________

(Notary Public signature and seal)

Power Of Attorney Form Page 3