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Power of Attorney
POWER OF ATTORNEY
The undersigned, of _____________________, have made,
constituted and appointed, and do make, constitute and appoint,
_____________________ of ___________________________ my true and
lawful attorney in fact, for me and in my name and stead, and to
my use, to _________________________ hereby giving to my attorney
in fact, full authority and power to do everything whatsoever
requisite or necessary to be done, as fully as I could or might
do if personally present, with full power of substitution and
revocation, hereby confirming and ratifying all that my said
attorney in fact shall lawfully do or cause to be done,
hereunder.
Dated:
___________________________ __________________________
Witness
Form 612
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