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Power of Attorney Agreement

I, ____(1)__, of ____(2)____, hereby appoint __(3)____, of (4)____, as my attorney in fact to act in my capacity to do every act that I may legally do through an attorney in fact. This power shall be in full force and effect on the date below written and shall remain in full force and effect until ___(5)____ or unless specifically extended or rescinded earlier by either party.

Dated (6)____, 19(7). ____(8)___

STATE OF _(9)___ COUNTY OF ____(10)__

BEFORE ME, the undersigned authority, on this (11) day of (12), 19(13), personally appeared (14)____ to me well known to be the person described in and who signed the Foregoing, and acknowledged to me that he executed the same freely and voluntarily for the uses and purposes therein expressed.

WITNESS my hand and official seal the date aforesaid. _____(15)____

NOTARY PUBLIC

My Commission Expires:(16)

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