BLANK CERTIFIED COPY OF POA FORM

State of California
County of _______________} ss.

I, _____________________________, Notary Public, certify that on ______________________, I examined the original power of attorney and the copy of the power of attorney. I further certify that the copy is a true and correct copy of the original power of attorney.


HOW TO COMPLETE THE CERTIFIED COPY OF POA FORM

State of California
County of Place where document signer appeared } ss.

I, Name of Notary Public , Notary Public, certify that on Date document signer appeared , I examined the original power of attorney and the copy of the power of attorney. I further certify that the copy is a true and correct copy of the original power of attorney.

Notary Public Signature
Notary Public Seal Imprint


SAMPLE COMPLETED CERTIFIED COPY OF POA FORM

State of California
County of San Diego} ss.

I, Bob Smith , Notary Public, certify that on January 1, 2000 , I examined the original power of attorney and the copy of the power of attorney. I further certify that the copy is a true and correct copy of the original power of attorney.

Bob Smith