NE Acknowledgment-Attorney-in-Fact 1

FORMS.--NO PARTICULAR FORM IS MANDATORY BY STATUTE. STATUTE DOES AUTHORIZE FOLLOWING (64-206):

Attorney in Fact:

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)