California General Durable Power Of Attorney Page 7

[Notary Seal, if any]:

_______________________________

(Signature of Notarial Officer)

Notary Public for the State of California

My commission expires: ___________________

ACKNOWLEDGMENT OF AGENT

BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT ASSUMES THE

FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES OF AN AGENT.

________________________________________________

[Typed or Printed Name of Agent]

________________________________________________

[Signature of Agent]

PREPARATION STATEMENT

This document was prepared by the following individual:

________________________________________________

[Typed or Printed Name]

________________________________________________

[Signature]

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