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IeSisla~an designed for the p~aeuion of plnonnel in the Mmed an~ agents, empioyeca and counsel i?rretofo~c or bereaftc~ em-
Forces w thci~ depcnde~ts: p!q•ed by me or in my behalf.
I61 to hirr. rngage. en~pby and appoint aaenis, employees and 10. ~11SCEl.1.A\EOl'S: ~o~ To siqn, uai, a~~knuwled~e and
counsrl upon such terms and cunditions and a~ :uch comprn- deliver a~~• i~strument neccsuh to accomplisb an~• of ~he po..en
satioo as my ssid Attorney•in-Faa shail d~em proper i~ ~he herein grao~rd;
exercise of tAe powYrs herein granted; to dismiu and remove (b) To modify, reform. ~enegotute o~ resci~d a~y cvnuxt or
at pkswre any such agrnts, employees and counse! as well as obiigation h~rctofore or hereafler made by me cu in my Ixhal[
GEN~RAL PROViSlONS: (s) All business ~raaaxtcd hercunder Eor me or for my accouot shall be transsc~ed in my name, a,nd ail ~
indorsemrnts and inttrumeMS executed by my Anomey-iu•Fact for the purpose of carrying out any of the (orego~ng Fw~+ers, shall con- ~
uin my name, folbweef by that of my Attomey-in-Fact and th~ designa~ion. "Attornry•-in-Fact"; r
(bf 1 hertby ratiFy anil confirm all tawlul acts done aad caused to be done by m~ said Atwrney-ia-Fact pur:uant to this Po~ver of At- ~
torney, and I dinct ~hat i1 sh:tli contiaue in efiect until the ~erminatiun date herein specified unkss sooner termiaatal by me or by opera-
tion of lah•. Not~.i~hstanding my inxnion of a:pecific expiratwn date hercia, IF oa said date I should be, or have betn, tarricd in a
nulitary status of "Atissing;' "\fissiog in Action," or "prisoncr of N'ar," this Power of Attorney shall sutomatically oa?tiaue to rc~~ain
valid and in lull effert until sixty (60) days alter I ha~r rrtumcd to lJNlTED STATES M1LITARV CONTROL folbwing termination
of such "Missing,"'~liuing in Aciim." "Prisoner," or "Prisoner of ~~'ar" sutw.
~s/ if ~he auihority oontswed herein shall be revoked or tc~mina~~d by opcrat~on of law without notitt. i h~rcby agrce for myseN,
executon, administ~aton, Aein and assigns, in consideratian'of my attorney's willingncu to act pursuant to ~his Pow~r of Attomey,
to save and hold my attorney harmless from any lou sutfered or any (iability incurred by my attorney in so acting after such rew- ~
ution or tcrmuutioe wilbout notite. "
(1) Unku soaner rcvoked by me or terminated by law, this Power o! Attorney shall be NUL ND VO on and after
In ~vitness wherrof, I have hercunto xe my hand anJ seal, this~_day of 19_~
w~~pt~:: is~L~
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Address and Service ~to. ~rjoRrl
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Address and Service No. ( eJ a~r )
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T~ Y
fF ACKNOWL~GED ~EFORE A NOTARY PUdUC: ~
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S~aie of ~ s
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Couni (Gty } u ~ ;
i. , s Yota~ry!~'blic in and for the Counry (Citv) and Sute aforesaid, do hereby ceniF ;
that on tht ~ day of y 19~LL, before me penonaUy appnred .~~a 11~1~_~1~ s
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~ who u knowa by me to be the idrni~cal person who ;
i~ dpc~,'~ ~i4,~i~ir~ieie stita~e is sub~uibed to, and who sisnod and cxecuted the fcxegoing iast~ument, and having 6nt made krown to '
him ~j'be t~ t~rbof, tje, (utsooally acknowkdged w me that he signed and sealed the same an the date it bean u his true, free
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an~ip~a J~ yH.~ieatkloi:tLe wa. purpo~es and ooasidc~ations tberein set forth. ~
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In1~~ea~ ~111iersot.; ~~vee.lleieunto aet my hand a~d official seal this day and year above. C
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' /l~+~l H'~~Y Public ~ ~i`
My ii~es~i`.~acR{[ta'.•~*: 9.~(~,
iE ACKNp1~ILEDQE~ ~OR~ A MIUTARY l~SON AUTNORtZED TO AOlIAINiSTER OATMt: p'~•:
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(Set AFR 110-6 for suuuNxy provisians authaizina Armed Forces Penonnd to perform IYotar~ai~s and fi~r~AG~~~~4i~~i com-
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pleein6 cereifiute ot scknowkd6mem.) ~j ~ ~9
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Wi~h the United Su~es Armed PorcK ~
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1. . ~he untlersi~ned officcr, do hercby cenify that day of ,
19 . before me. penonally apprared 5~I , wlwse 1wm~ sddrrss is
~ . whp iy Icnpwn lo mc to bt rn.
aad to be the idenqG}I pt,~soa w~o is descr~bcd in. wFw~e namc u wb-
a~ibed to, aad wbo a~a! sod a~ecvted d~e foro~oie~ inwumna. ud havins 6nt~ kaowa a him tbc oantaus themnf, he personaly ~c- ~ 3
knowleised a me iha~ he ~;oed sud seakd the same. on ~he date n beus as his true. troe snd wluaury aa a~d i3.-ed. iw thr
wcs, purposes and coosderanoas tl~ei~ sa tortA. Aad ! do furthn cKUfr ~bai ~ t ~te s oomm?s~~i
offioer of the 6rade. ~ancA d~ervioe aod onjani~~ion suled,_trtow in ihe u~?v~~~ cd Forccs. tAa~ Iw
~ aaiu~e ao aeal 'u nquired on Urs oertifics~e aad tAat saene is exetwed in mp cap~cit~:a~': 71:~~..;..;__
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W { oature er1 IService No., 6rade arwl Sranch of srra~c~1 ,1 •
a . CLEF2Y. C{RCUIT COURT ~
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: ; ( ~ or et~tr~tion) ( raw?rnt addres~)
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