#2400 @001 Enter the name of the PRINCIPAL: @002 Enter the name of the ATTORNEY: @240 Enter the state where executed: @241 Enter the county where executed: @242 Enter the date when the power of attorney was executed: @243 Enter the date when the power of attorney became effective: @244 Enter the name of the person requesting the affidavit: #end control section #2400 /* Para. 2400: Affidavit that POA is still in effect */ AFFIDAVIT OF CONTINUATION OF POWER OF ATTORNEY STATE OF @240 COUNTY OF @241 @002, having been sworn or affirmed to tell the truth, states: WHEREAS, on @242, @001 executed a power of attorney naming myself as their attorney in fact, and, WHEREAS, on @243 I began to act under that power, and, WHEREAS, @244 is requesting verification that the power is still in force and effect, I, @002, having personal knowledge of the facts and circumstances herein, certify that the power of attorney referred to herein is still in full force and effect and that I am not aware of any event which would result in the power of attorney lapsing having taken effect. Dated: ________________________________________ ________________________________________________________ @002 Sworn to and subscribed before me on ___________________, 199___. _______________________________________________________ Notary Public My Commission Expires: