Fill and Sign the 1 Statutory Power of Attorney Section 45 5b 301 Form

AFFIDAVIT AS TO PRINCIPAL'S COMPETENCE AT TIME OF GRANTING POWER OF ATTORNEY State: ___________________ County: ___________________ Affiant: ___________________ (Name and Address) Affiant, on oath, swears that the following statements are true: 1. I am personally aware of the execution of the Power of Attorney dated ___________________ , signed by ___________________ (Name of Principal) in favor of ___________________ (Name of Attorney-in-Fact) (if recorded, provide recording information). 2. Based on my personal observations of ___________________ (Name of Principal), I can state with certainty that on (Date of Power of Attorney), (Name of Principal) was alive, under no disability, and of sound mind. This Affidavit is signed by me on the date of acknowledgment of my signature. ___________________________Affiant (The following acknowledgement is not geared toward the law of any particular state and is subject to modification) ACKNOWLEDGMENT State of _____________________________ County of _____________________________ On _____________________________, _____________________________ personally appeared before me and proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of _____________________________ that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature of Notary (Seal) My Commission Expires _____________________