MO Acknowledgment-Attorney-in-Fact 1

STATE OF MISSOURI)

)ss.

COUNTY OF _____________)

On this _______ day of ___________________ in the year 20_____, before me, a Notary Public, in and for said state, personally, appeared _____________________

_____________________________, attorney-in-fact for _______________________

______________________ known to me to be the person who executed the within instrument in behalf of said principal (or surety), and acknowledged to me that ______ executed the same for the purposes therein stated.

________________________________ Notary Public

My Commission Expires: ___________

No guidelines are available for this form at this time.