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<br /> � STATEMENT OF WITNESa
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<br /> < On the date written above, the principal declar�ed ta me in my presence that this instrument i� '�
<br /> hi� generai durable power of att�rney and that he ar�he had willingly signed oc direc#ed �;
<br /> �� anather ta sign for him or her, and that he or she executed it as his or her free and voluntary s;
<br /> >� act for the purposes therein expr�ssed. �>
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<br /> [Signa#ure of Witness#1] ;;
<br /> � [Printed or typ�d name of 1Nitness#1� `�'
<br /> `�� � � [Address of Witness#1, Line 1] `�'
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<br /> ;; _ [5ignature of Wi�ness#2] :r
<br /> < <✓'' [Printed or typed name of Witness #2] ;;
<br /> I << .%�.7t�;,� r:� fl� �v� �� r 5" [Address af Witness#2, Line 1] ���
<br /> I ,l �,�,�.�,�,� �� � � Y [Address of Witness#2, Line 2] �_;
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<br /> ; � A Note Abou#Selecting Witnesses; The agent (attorney-in-fact) may not also �`.
<br /> '�� serve as a witness. Each witness must be present at�he time that principal signs ��
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<br /> ��' the Power of Attorney in front of the notary. Each witness must be a mentally I��
<br /> <` comp�tent adult, VVitnesses shou{d ideaily reside ciose by, so that they wili be ;s
<br /> ;; easily accessible in #he event they are one day needed to affirm fhis document's
<br /> validity.
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<br /> �� Page� t�f 7 `��
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