Power Of Attorney - Authorization For Certain Gift Transactions Page 3

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Power of Attorney, NY Statutory Gifts Rider
Effective 09/12/2010
(e) SIGNATURE AND ACKNOWLEDGMENT:
In Witness Whereof I have hereunto signed my name this _________ day of ____________, 20____.
(PRINCIPAL SIGNS HERE:) ►__________________________________________
(Signature of Principal)
STATE OF NEW YORK
:
: ss.:
COUNTY OF ___________ :
On the _________ day of ______________ in the year _______ before me, the undersigned,
personally appeared __________________________________________, personally known to me or
proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are)
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or
the person upon behalf of which the individual(s) acted, executed the instrument.
____________________________
Notary Public
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