AFFIDAVIT OF PRINCIPAL THAT POWER OF ATTORNEY REMAINS IN FULL FORCE

STATE OF _____________________

COUNTY OF ___________________

PERSONALLY appeared before me,_____________________________, hereinafter “Principal”, who being duly sworn by me states upon his or her oath and personal knowledge the following:

1. Principal resides in ______________ County.  The Principal signed a written Power of Attorney on ____________________, 20___ , appointing _______________________ as his/her attorney-in-fact, hereinafter “Agent”. (A true copy of the power of attorney is attached hereto and incorporated herein.)

2.         As Principal I hereby certify that the Power of Attorney referenced above remains in full force and has not been revoked, amended or cancelled by me, or by operation of law.

1. Since the date of execution of the Power of Attorney, all actions of my Agent pursuant to the power of attorney are fully recognized by me as binding.
2. My Agent remains empowered to act pursuant to the power of attorney and said agent has not been removed as my attorney-in-fact.

DATED this the ____ day of ___________, 20___ .

Principal

     ____________________________________

___________________________________

____________________

Witness

Print Name: ________________________

__________________________________

Witness

Print Name: ________________________

Sworn to and subscribed before me on this the ____ day of ___________, 20__ .

_____________________________

Notary Public

My Commission Expires:________________________

State Specific Power of Attorney Forms

—-For State Specific Power of Attorney Forms you can download in Word Format go to

http://www.uslegalforms.com/powerofattorney/