Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 1

DELARATION STATEMENT AND RECEIPT FOR POWER FOR ATTORNEY {FIDUCIARY TRUSTEE}

October 13, 2022

Financial Institution: Peco an Exelon Company

Date: October 13, 2022

Account Access: 190529658

1. I, Johnny Easley, being the lawful fiduciary for the beneficiary, John Johnny Jamie Easley, do
hereby state that the attached hereto is a true and correct original Power for Attorney and
fiduciary Trustee for the Beneficiary, John Johnny Jamie Easley.

2. I further state that this statement and receipt is effective and supersedes all previous
statements.

3. This statement and receipt do hereby induce the Federal Deposit Insurance Corporation to
deposit the insurance covering the above referenced account to the full extent that the Account
is covered by insurance.

4. This statement and receipt is hereby executed in alignment with the supreme law for the land
and all laws created by the state in alignment with the supreme law for the land.

In honour by our sovereign hand,

Fiduciary {Attorney in fact} autograph .

Date autographed October 13, 2022


Mailing location: 26 Meadow Ln, Norristown, Pa. 19403

*No personal or private information shall be taken for public use without just compensation.

FDIC 7200/16 [9-04]

You might also like