CO 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.