POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS that ____________________________________________________ DO HEREBY make, nominate, constitute, and appoint ____________________________________________________ true and lawful Attorney for me and in my name, place, and stead and for sole use and benefit to: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ And for all and every of the purpose aforesaid do hereby grant and give unto my said Attorney full and absolute power and authority to do and execute all acts, deeds, matters, and things necessary to be done in and about the premises, and also to commence, institute, and prosecute all actions, suits, and other proceedings which may be necessary or expedient in and about the premises as fully and effectually to all intents and purposes as I could do personally present and acting therein. I am hereby ratifying and confirming and agreeing to ratify and confirm and allow all and whatsoever my said Attorney (or such substitute or substitutes, is allowed) shall lawfully do or cause to be done in the premises by virtue hereof. IN WITNESS WHEREOF I have hereunto set my hand and seal this __________ day of ________________________ , 19 _______ . SIGNED, ) SEALED, ) AND ) ____________________________________________ DELIVERED ) ---------------------------------------------------------------- AFFIDAVIT OF EXECUTION I, _____________________________ of ____________________________ MAKE OATH AND SAY: 1. That I was personally present and did see ____________________________________________ named in the within instrument who is personally known to me to be the person named therein, duly sign, seal, and execute the same for the purposes named therein. 2. That the same was executed at _______________________ , and that I am a subscribing witness thereto. 3. That I know the said _________________________________ , and in my belief her/she is of the full age of majority. SWORN BEFORE ME AT ) _________________________ ) _________________________ ) ____________________________________ THIS _____________ DAY OF ) _______________ , 19 ____ ) ____________________________ A Notary Public etc. ---------------------------------------------------------------- NOTES: There are a number of blanks herein, and each is not being identified separately. The following two clauses may be added, if desired. "I also grant my Attorney full power and authority for my said attorney to appoint a substitute or substitutes and such substitution at pleasure to revoke." "I expressly provide that the authority of my said attorney shall not terminate but shall continue notwithstanding any mental infirmity which I may suffer."