Affidavit By Attorney-In-Fact

STATE OF ----------)

) s.s.:

COUNTY OF ---------)

[Name in capital letters] (Affiant), being duly sworn, says:

1. I reside at [address, city, state of Affiant].

2. I am Attorney-in-Fact for [name of principal] under power of attorney executed by [principal], dated [date]. As of the date of this Affidavit, [principal] is alive and well, and has agreed to the terms of [description of contract, e.g., sale of real estate property, goods and chattel, etc.].

3. This Affidavit is made for the purpose of inducing [name] to [description of purpose, e.g., to induce a party to accept a conveyance, a bank to provide a loan].

[signature]

Attorney-in-Fact

[signature]

*** If Required By FederaL or State Law ***

This Section for Notary:

ACKNOWLEDGMENT

State of _________

County of ________ [COUNTY]

On [DATE] before me, [NAME OF NOTARY], notary, personally appeared [NAME OF PERSON(S) INVOLVED], personally known to me (or 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.

Witness my hand and official seal.

Signature ________
Notary

My commission expires: _____

(Seal)