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AGENT'S CERTIFICATION AS TO THE VALIDITY OF POWER <br /> OF ATTORNEY AND AGENT'S AUTHORITY <br /> State of Colorado <br /> County oft <br /> j, C ) (Name of agent), certify under penalty of perjury that <br /> i - _ , (Name of principal) granted me authority as an agent or <br /> successor in a power of attorney dated _ <br /> I further certify that to my knowledge: <br /> (1) The principal is alive and has not revoked the power of attorney or my authority to act under <br /> the power of attorney and the power of attorney and my authority to act under the power of <br /> attorney have not terminated; <br /> (2) If the power of attorney was drafted to become effective upon the happening of an event or <br /> contingency, the event or contingency has occurred; <br /> (3) If I was named as a successor agent,the prior agent is no longer able or willing to serve; and <br /> (`1) <br /> (Insert other relevant statements) <br /> SIGNATURE AND ACKNOWLEDGMENT <br /> Agent's signature Date <br /> Agent's name printed <br /> Agent's address <br /> Agent's telephone number <br /> State of Colorado <br /> County of :f u-eR <br /> This document was acknowledged before me on <br /> (Date) <br /> by ') 1- -�c7 . . L � .-_ , <br /> (Name of agent) <br /> (-9M9JW yuN <br /> Stignkure of notary NOTARY PUBLIC <br /> STATE OF COLORADO <br /> My commission expires:y-1 ` Z NOTARY ID 20154014343 <br /> MY COMMISSION EXPIRES APRIL 9,2023 <br /> This document was prepared by: <br />