Power of Attorney Affidavit

Affiant Name:
Address:
City/State/ZIP:
Principal Name:
Principal Address:
City/State/ZIP:

I, , being duly sworn, hereby affirm that I am the attorney-in-fact, agent, or representative named in the attached Power of Attorney (the "PoA") executed by on . To the best of my knowledge and belief, the Power of Attorney has not been revoked, terminated, or rendered invalid by the principal or by operation of law. I am authorized to act as indicated in the Power of Attorney for the best interest of the principal.

This Affidavit is made to confirm my authority to act under the Power of Attorney and for reliance by any parties accepting this document.

Date:
Signature of Affiant
Printed Name of Affiant

Notary Acknowledgment

State of
County of
Subscribed and sworn before me on this day of , .
Notary Public