Tele 610-935-7756
|
George F. Reitnour
Attorney at Law
|
612 W. Seven Stars Road
Phoenixville, PA 19460
|
RECEIPT
I, _________________________________, hereby acknowledge receipt from George F. Reitnour of the only original Power of Attorney to have been held by George F. Reitnour which was executed by the principal, ___________________________________, on _____________________(date signed).
I understand that I should consult with an attorney immediately regarding the validity, care, use of this document.
_____________________(signature of principal presenting proof of identity, or signature of duly authorized agent who presents proof of identity and completes the below affidavit, and if required, the below acknowledgment)
Date:__________________
STATE OF ____________________________:
:SS
COUNTY OF __________________________:
AFFIDAVIT
I, _______________________, agent by power of attorney executed by _________________________ (the "Principal") on the ___ day of _______________, ______ make this affidavit pursuant to 20 PACS§5606 (which provides that my execution of this affidavit shall constitute conclusive proof of the nonrevocation or nontermination of the power of attorney).
I hereby aver that I do not have actual knowledge of the termination of the said power of attorney by revocation or death of the Principal. I hereby aver that either I have never been married to Principal, or if I am married to Principal, I do not have actual knowledge of the filing of an action of divorce.
________________________________
Agent
Sworn to and subscribed
before me this _______ day
of ________________, __________.
______________________________
STATE OF ____________________________:
:SS
COUNTY OF __________________________:
ACKNOWLEDGMENT
I, __________________________, whose name is signed below as Agent, do hereby declare that I have read the attached or foregoing Power of Attorney and am the person identified as the Agent for the Principal. I hereby acknowledge that in the absence of a specific provision to the contrary in the Power of Attorney or in 20 Pa.C.S. when I act as Agent:
I shall exercise the powers for the benefit of the Principal.
I shall keep the assets of the Principal separate from my assets.
I shall exercise reasonable caution and prudence.
I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal.
Dated:_________ Agent__________________
|