Form 5297 Power of Attorney

OMBNo.1651-0050
MUSTBETYPED.
1 . THISFORM
DEPARTMENT
OFHOMELAND
SECURITY
CBPUSEONLY
THISFORM.
2 . DONOTALTER
DATE
RECEIVED
U.S,Customs
andBorder
Protection
ORIGINAL
TO
BE
SUBMTNED
3.
(See
TOCBP.
Option
explained
CORPORATE
SURETY
POWER
OFATTORNEY
InInstruction
No,2.)
GRANT T-1 CHANGE
toGrant
onfile
EFFECTIVE
REVOCATION.Thebelow-described
DATE
n
l-l
| | (lnstruction| | (lnstruction
| |
powers
No.3b.)
previously
granted
arehereby
(lnstruction
No.3a.)
revoked.
No,3c.)
NAME
o
N
N

GRANTEE:

ADDRESS
LJThisis
a name
chanoe

LlThisis an
address
change

SOCIALSECURITY
NUMBER

N
N

ci
0q
l

/h
l/
rs

GRANTOR:

SURETY
COMPANY'S
CORPOMTE
NAME

SURETY
NO.

STATE
UNDER
WHOSE
LAWS
ORGANIZED
ASA SUREW

-0R-port(s)
Portcode(s)for
CBPport(s)
inwhichauthorized
todobusiness
grant,
andlimitonanysingleobligation
beingadded
totheoriginat
PORT

LIMIT

PORT

LIMIT

PORT

LIMIT

PORT

LIMIT

PORT

LIMIT

PORT

LIMIT

Granhrappointstheabove.namedperson(Grantee)asitsattomey|nfacttosignitsnameassuretyto,andtoexeote,sea|,andack
corporation
t0thesameext€ntasif donebya regularly
elected
officer,
limited
onlytoth€extentshonrn
portandamount
aboveasto Customs
andBorder
Poteclion
onanyslngle
bondob|iga|ion'Thisgr ant'orchangetoagrantonfi|e,orrevocation,asspecifed,sha||bemmeactiveontheeffec1ivedateshown
of|ce5day8beforeth€€ff9ctivedateghoin;oherW|9ethespec|tle! qct|onswi||becomeac1|veatthec|oseofbus|ness5work|ngdaysa
Inwitn$swhereof,
thesaidGrantor,
by DateAttested
Name
andTitle
Name
andTitle
virtueof authority
confenBd
byltsBoard
of Dircc'tors,
hascaused
thesepr€senb Usea facaimlle
of corporate
withib comonate
to besealed
sealand seal, and not impression
Signature:
Signature:
aftested
byanytwoprincipal
officens, seal,

orm5297