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- #2400
- @001 Enter the name of the PRINCIPAL:
- @002 Enter the name of the ATTORNEY:
- @240 Enter the state where executed:
- @241 Enter the county where executed:
- @242 Enter the date when the power of attorney was executed:
- @243 Enter the date when the power of attorney became effective:
- @244 Enter the name of the person requesting the affidavit: