Notary Acknowledgement (Must be completed by Notary)
State of
County of
Subscribed,
Sworn and acknowledged before me by
, the
Principal, and subscribed and sworn to before me by
,
witness, this
day of
.
Notary Signature
Notary Public
In and for the County of
State of
My commission expires:
Seal
Acknowledgement and Acceptance of Appointment as Attorney-in-Fact
I,
have read the attached power of attorney
Name of Attorney-in-Fact
and am the person identified as the attorney-in-fact for the principal. I hereby
acknowledge that accept my appointment as Attorney-in-Fact and that when I
act as agent I shall exercise the powers for the benefit of the principal; I shall
keep the assets of the principal separate from my assets; I shall exercise
reasonable caution and prudence; and I shall keep a full and accurate of all
actions, receipts and disbursements on behalf of the principal.
Signature of Attorney-in-Fact
Date
Acceptance of Appointment as successor Attorney-in-Fact
I,
have read the attached power of
Name of successor Attorney-in-Fact
attorney and am the person identified as the successor attorney-in-fact for the
principal. I hereby acknowledge that I accept my appointment as Successor
Attorney-in-Fact and that, in the absence of a specific provision to the contrary
in the power of attorney, when I act as agent I shall exercise the powers for
the benefit of the principal; I shall keep the assets of the principal separate
from my assets; I shall exercise reasonable caution and prudence; and I shall
keep a full and accurate record of all actions, receipts, and disbursements on
behalf of the principal.
Signature of Successor Attorney-in-Fact
Date