Customs Power Of Attorney Form (Page 2 of 2) in pdf

Customs Power Of Attorney Form Page 2

11 INDIVIDUAL OR PARTNERSHIP CERTIFICATION

CITY

______________________

COUNTY ___________________ SS: __________________________

STATE

_____________________

On this ____________ day of ________________, 20______, personally appeared before me _______________________

residing at ______________________________________________, personally known or sufficiently identified to me,

who certifies that ______________________________________ (is) (are) the individual (s) who executed the foregoing

instrument and acknowledge it to be ___________________________________ free act and deed.

___________________________________________________

(Notary Public)

CORPORATE CERTIFICATION

(To be made by an officer of other than the one who executes the power of attorney)

I,12

,certify that I am the13

of 14

organized under the laws of the State of 15

that 16

, who signed this power of attorney on behalf of the donor,

is the 17

of said corporation; and that said power of attorney was duly signed,

and attested for and in behalf of said corporation by authority of its governing body as the same appears in a resolution of the

Board of Directors passed at a regular meeting held on the 18

day of

, now in my possession or

custody. I further certify that the resolution is in accordance with the articles of incorporation and bylaws of said corporation and

was executed in accordance with the laws of the State or Country of Incorporation.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of said corporation, at the City of

______________________ this _________ day of ___________________________, 20_____,

19______________________________________________

_______________________________________________

(Signature)

(Date)

Customs Power Of Attorney Form Page 2