Power of Attorney Authorization

POWER OF ATTORNEY AUTHORIZATION

This Power of Attorney Authorization is made by Principal Name: whose residence and mailing address is Principal Address: . Agent/Attorney-in-Fact Name: whose address is Agent Address: . Date Executed:

RECITALS

WHEREAS, Principal desires to appoint Agent to perform on Principal's behalf certain acts and to exercise certain powers with respect to Principal's property, financial affairs and legal matters as set forth in this instrument;

WHEREAS, Principal affirms that Agent is a trusted person to act in Principal's best interests and that Agent's authority shall include the duties, powers and limitations described below;

WHEREAS, Principal intends that this Power of Attorney be a general grant of authority, subject to any limitations stated herein, and that third parties may rely upon the Agent's actions taken pursuant to this authorization;

NOW, THEREFORE, in consideration of the foregoing recitals and the mutual covenants contained herein, Principal hereby grants and appoints Agent as Principal's true and lawful attorney-in-fact on the terms and conditions set forth below.

1. APPOINTMENT AND SCOPE

Principal hereby appoints Agent as Principal's attorney-in-fact with full power and authority to act for Principal in Principal's name, place and stead to the full extent permitted by law. The powers granted are broad and inclusive and are intended to constitute a general power of attorney covering, without limitation, the specific powers set forth in Section 2 below. Unless otherwise limited herein, Agent may exercise any right, power or authority that Principal could exercise personally.

This Power of Attorney is: Durable (survives subsequent incapacity) Non-durable (terminates upon incapacity)

2. SPECIFIC POWERS

Agent is specifically authorized, but not limited, to take the following actions on behalf of Principal. The enumeration below is illustrative and does not limit the general grant in Section 1.

Real Property: Acquire, convey, mortgage, lease, manage, and settle claims relating to real property, to sign deeds, mortgages, and related documents, and to receive and disburse proceeds.

Personal Property: Buy, sell, transfer, insure, and otherwise manage tangible and intangible personal property.

Banking and Financial Transactions: Open, maintain and close accounts; sign checks and withdrawal slips; endorse checks; transfer funds; and access safe deposit boxes.

Business Interests: Operate, buy, sell, encumber and otherwise manage business interests, including formation and dissolution acts and execution of documents necessary for business operations.

Tax Matters: Prepare, sign and file tax returns and forms, obtain tax information, represent Principal before tax authorities, and handle refunds and audits.

Legal and Governmental Affairs: Initiate, defend or settle legal claims; retain counsel; and execute releases, stipulations and other instruments.

Personal and Family Maintenance: Make payments for health care, housing, education, support and other ordinary living expenses for Principal and Principal's dependents consistent with Principal's standard of living.

Health-Care Authority: Agent is expressly authorized expressly not authorized to make health care decisions for Principal. If health-care authority is included, Agent's health-care decisions shall be subject to any limitations set forth in Special Instructions below.

3. EFFECTIVE DATE AND DURATION

This Power of Attorney shall become effective on the date specified below and shall remain in effect until revoked in accordance with Section 5 below or until the termination date indicated. Effective Date: Termination Date (if any):

4. THIRD-PARTY RELIANCE

Third parties dealing with Agent may rely upon a copy of this instrument and on Agent's representations without further inquiry as to the validity or extent of Agent's authority. A person that accepts a copy of this Power of Attorney may rely conclusively on the authority of Agent until that person has received actual written notice of revocation.

5. REVOCATION; NOTICE

Principal may revoke this Power of Attorney at any time by providing written notice to Agent and to any third party reasonably known to Agent to be relying on this Power of Attorney. Revocation shall not affect actions taken by Agent in reasonable reliance on this Power of Attorney prior to receipt of actual notice of revocation.

6. SUCCESSOR AGENT

If Agent is unable or unwilling to serve, the following successor is appointed to serve with the same powers and duties: Successor Agent Name: Successor Agent Address:

7. COMPENSATION; BOND

Agent shall be entitled to reasonable compensation for services rendered if so elected by Principal. Principal elects that Agent be: compensated not compensated

Principal directs that Agent shall not be required to post bond unless a court of competent jurisdiction affirmatively orders a bond.

8. RECORDKEEPING; ACCOUNTING

Agent shall keep accurate records of receipts, disbursements and transactions made on behalf of Principal and shall make such records available to Principal or to any court or other person entitled to them upon reasonable request.

9. GOVERNING LAW

This Power of Attorney shall be governed by and construed in accordance with the laws of the State of .

10. MISCELLANEOUS

Entire Agreement. This Power of Attorney constitutes the entire agreement between the parties with respect to the matters contained herein and supersedes any prior powers of attorney relating to the same subject matter, unless expressly provided otherwise in writing.

Severability. If any provision of this instrument is held to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Amendments; Waiver. This instrument may be amended or revoked only by a written instrument signed by Principal. Failure to promptly enforce any right shall not be construed as a waiver of that right.

Counterparts. This Power of Attorney may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument.

11. AGENT ACCEPTANCE

By signing below, Agent accepts the appointment and agrees to exercise the powers granted hereunder in accordance with applicable law, in Principal's best interests, and in good faith. Agent acknowledges a duty to keep records and to avoid conflicts of interest.

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