State Of Ohio Statutory Form Power Of Attorney Cover Letter Page 7

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RELIANCE ON THIS POWER OF ATTORNEY
Any person, including my agent, may rely upon the validity of this power of attorney or
a copy of it unless that person knows it has terminated or is invalid.
SIGNATURE AND ACKNOWLEDGMENT
_________________________________________ ________________________________
Your Signature
Date
_________________________________________
Your Name Printed
__________________________________________________________________________
Your Address
(___________)_____________________________
Your Telephone Number
STATE OF OHIO
COUNTY OF ______________________________
This document was acknowledged before me on __________________________ (Date), by
__________________________________________________________ (Name of Principal).
_________________________________________
Signature of Notary
My commission expires: ______________________________________________________
This document prepared by:
_________________________________________
_________________________________________
_________________________________________
_________________________________________
State of Ohio ‐ Statutory Form Power of Attorney 
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