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Limited Power of Attorney

BE IT KNOWN, that I ________, the undersigned, do hereby grant a limited power of attorney to ________ as my attorney.

My attorney shall have full power and authority to undertake and perform the following on my behalf:

(Describe specific authority)

My attorney agrees to accept this appointment subject to its terms, and agrees to act and perform in said fiduciary capacity consistent with my best interests as he/she in his/her discretion deems advisable.

This power of attorney may be revoked by me at any time, provided any person relying on this power of attorney shall have full rights to accept the authority of my attorney until in receipt of actual notice of revocation.

IN WITNESS WHEREOF, the parties hereto have executed this Limited Power of Attorney.

Signed this ________ day of ________, 20 __.

Attorney

Signature

Print Name and Title

Undersigned

Signature

Print Name and Title

ACKNOWLEDGEMENT BY NOTARY PUBLIC

State of ________)

) SS.:

County of________)

On ________, before me, ________, [NAME OF NOTARY], personally appeared ________, [NAME OF PERSON(S) INVOLVED], who proved to me on the basis of satisfactory evidence to be the person(s) whose names(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 signatures on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under the 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]

Name of Notary

Notary Public

My Commission Expires

[SEAL]