(Top 3 inches reserved for recording data) AFFIDAVIT BY ATTORNEY-IN-FACT of nontermination or nonrevocation Minn. Stat. 523.17, subd. 1 State of Minnesota, County of Minnesota Uniform Conveyancing Blanks Form 100.2.1 (2011) , being first duly sworn, on oath says: 1. Affiant is the Attorney-in-Fact (or agent) named in that certain Power of Attorney dated for record on , as Document Number (or in Book (month/day/year) , and filed of County, Minnesota, , as Grantor and Principal, Page ), in the Office of the County Recorder Registrar of Titles of (check the applicable boxes) executed by relating to real property in County, Minnesota, legally described as follows: Check here if all or part of the described real property is Registered (Torrens) 2. Affiant does not have actual knowledge and has not received actual notice of the revocation or termination of the Power of Attorney by Grantor's death, incapacity, incompetence or otherwise, or notice of any facts indicating the same. 3. Affiant has examined the legal description(s), if any, attached to the Power of Attorney and certifies that the description(s) has(have) not been changed, replaced, or amended subsequent to the signing of the Power of Attorney by the Principal. Note: Remainder of page left blank, signature page follows. (v2) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 (v2) Minnesota Uniform Conveyancing Blanks Form 100.2.1 Affiant (signature) Signed and sworn to before me on (month/day/year) , by (insert name of person making statement) . (Stamp) (signature of notarial officer) Title (and Rank): My commission expires: (month/day/year) THIS INSTRUMENT WAS DRAFTED BY: (insert name and address) American LegalNet, Inc. www.FormsWorkFlow.com