KNOW ALL MEN BY THESE PRESENTS THAT I, ________________________ ____________________, have constituted, ordained, and made, and in my stead and place put, ____________________________________ to be my true, sufficient, and lawful Attorney, and in my name and stead to use, ask, demand, levy, require, recover, and receive of and from any person or persons, whomsoever, all and singular sum or sums of money, debts, goods, wares, merchandise, effects, and things whatsoever and whereinsoever they shall be found due, owing, payable, belonging, and coming unto me, the constituent, by any means whatsoever and to sign and endorse checks, drafts, bills and notes in my name and in my stead, and to be a lawful signatory on any account in my name, in any bank or trust company.


IN WITNESS WHEREOF ______________ have hereunto set _________ hand and seal this _____________ day of __________ (month) in the year of our Lord one-thousand nine-hundred and ___________, signed and sealed ____________________

_________ in the presence of _____________________________________________.