Statement Of Foreign Entity Authority Sample Form Page 3

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Disclaimer:
This form/cover sheet, and any related instructions, are not intended to provide legal, business or tax advice, and are
furnished without representation or warranty. While this form/cover sheet is believed to satisfy minimum legal
requirements as of its revision date, compliance with applicable law, as the same may be amended from time to time,
remains the responsibility of the user of this form/cover sheet. Questions should be addressed to the user’s legal,
business or tax advisor(s).
AUTHORITY
Page 3 of 3
Rev. 6/28/2011

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