SPECIAL POWER OF ATTORNEY

I, ______________________, of legal age, with postal address at

_______________________, do hereby name, appoint and designate
__________________, with postal address at ________________,
to be my true and lawful attorney-in-fact, to do the following acts and
deeds:

1. To represent _______ in any and all proceedings before the

____________, with the possibility of settlement under terms and
conditions acceptable and favorable to ________.

2. To do any acts necessarily related and connected to the above

premises.

This Special Power of Attorney is issued this _____ day of _______

2013.

____________________________
NAME

SUBSCRIBED AND SWORN to before me this _____ day of

October 2013, Affiant exhibiting his Driver’s License No.
_______________ expiring on ___________.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2013.

NOTARY PUBLIC

Doc. No. _______;

Page No. _______;
Book No. _______;
Series of 2011.