Fill and Sign the Validity Power Attorney 497322554 Form

AGENT'S CERTIFICATION AS TO THE VALIDITY OF POWER OF ATTORNEY AND AGENT'S AUTHORITY State of Ohio County of ______________________________ I. ______________________________ (Name of Agent), certify under penalty of perjury that ______________________________ (Name of Principal) granted me authority as an agent or successor agent in a power of attorney dated ______________________________ . I further certify that to my knowledge: (1) The Principal is alive and has not revoked the Power of Attorney or my authority to act under the Power of Attorney and the Power of Attorney and my authority to act under the Power of Attorney have not terminated; (2) If the Power of Attorney was drafted to become effective upon the happening of an event or contingency, the event or contingency has occurred; (3) If I was named as a successor agent, the prior agent is no longer able or willing to serve; (4) ______________________________ (Insert other relevant statements). SIGNATURE AND ACKNOWLEDGMENT ____________________________________________ ___________________ Agent's Signature Date ______________________________ Agent's Name Printed ______________________________ Agent's Address ______________________________ Agent's Telephone Number State of Ohio County of ______________________________ This document was acknowledged before me on ____________________ (Date) by ______________________________ (Name of Agent). ____________________________________________ Signature of Notary My commission expires: ____________________________ This document prepared by: ______________________________ ______________________________ .