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To delegate in whole or in part any or all of the powers herein granted or conferred,
by means of an instrument in writing in favor of any third person or persons whom said
attorney-in-fact may select;
HEREBY GIVING AND GRANTING unto my said attorney-in-fact full power and
authority whatsoever requisite or necessary to be dine in and about the premises as fully
to all intents and purposes as I might or could lawfully do if personally present, hereby
ratifying and confirming all that my said attorney-in-fact shall lawfully do or cause to be
done by virtue of these presents.
____________________________________
Affiant
Competent Evidence of Identity
ID : _________________
Issued on : ___________
At : _________________
SIGNED IN THE PRESENCE OF
____________________________ ____________________________
________________ ________________
Witness Witness
ACKNOWLEDGEMENT
SUBSCRIBED and SWORN TO before me on the date and at the place indicated
below. The affiant exhibited to me her competent evidence of identity as indicated above,
known to me to be the same person who executed the foregoing instrument and
acknowledged to me that the same is her free act and deed.
Notary Public