I, __________, of __________, hereby appoint __________, of __________,
as my attorney in fact to act in my capacity to do every act that I may
legally do through an attorney in fact. This power shall be in full
force and effect on the date below written and shall remain in full force
and effect until __________ or unless specifically extended or rescinded
earlier by either party.

Dated __________, 19____.

By: __________

STATE OF __________COUNTY OF __________

BEFORE ME, the undersigned authority, on this __________ day of
__________, 19_____, personally appeared __________ to me well known to
be the person described in and who signed the Foregoing, and acknowledged
to me that he executed the same freely and voluntarily for the uses and
purposes therein expressed.

WITNESS my hand and official seal the date aforesaid.

NOTARY PUBLIC
My Commission Expires:

At Munley, Munley & Cartwright, our goal is to provide exceptional legal services to our clients. We strive to achieve the highest standard of excellence for the protection of individual rights through team work and the use of our considerable resources and experience. For a free consultation regarding your legal concerns, please submit the below, or call us at: 1-800-318-LAW1