OH Acknowledgment-Attorney in Fact 1

State of __________________

County of ________________

The foregoing instrument was acknowledged before me this (date) by (name of attorney in fact) as attorney in fact on behalf of (name of principal).

_______________________________________

(Signature of person taking acknowledgment)

_______________________________________

(Title or Rank)

(Serial number, if any)

No guidelines are available for this form at this time.