NV Acknowledgment-Attorney-in-Fact 1

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NV Acknowledgment-Attorney-in-Fact 1

Form Document
09/30/2005
V 1

STATE OF NEVADA)

) ss.

COUNTY OF _____________________)

ON ____________________________, 20_____ before me, the undersigned, a Notary Public in and for said State, personally appeared _______________________________, known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument, as the Attorney-in-Fact of ______

__________________________________________________ and acknowledged to me that ___ he subscribed the name of _________________________________________

thereto as principal ______ and h _____ own name as Attorney-in-Fact.

WITNESS my hand and official seal.

_______________________________

_______________________________ NAME (TYPED OR PRINTED) Notary Public in and for said State

[SEAL]

STATE OF NEVADA,)

) ss.

COUNTY OF _______________________)

On this ________ day of ____________________, A.D. 20_____, personally appeared before me, a notary public, in and for ________________________ County, ___________, known (or proved) to me to be the person whose name is subscribed to the within instrument, as the attorney-in-fact of ___________________

___________________________________________, and acknowledged to me that ___ he subscribed the name of ____________________________________________

thereto as principal, and h _____ own name as attorney-in-fact, freely and voluntarily and for the uses and purposes therein mentioned.

_____________________________________

Notary Public in and for said County and State

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