Delegation of Authority

I, _____________________ of _______________, hereby delegate to _____________

Name Address

________________________ of ___________________ an employee of____________

Name Home address Name of Company

The performance of all undertakings in the pursuit of the recovery of damages and penalties against persons suspected of theft or merchandise from ____________________ including, but not limited to, the following actions:

Name of Company

1. The making of demands for payment of the civil damages and civil penalties authorized under state law.
2. The filing of complaints and, where allowed by law, representation of __________________ interests in the courts of this state:
3. Other representation of (name of company_______________________ interests in regard to such alleged incidents.

Dated ______19____ _________________________________________

Signature of official or owner

Typed Name

Typed title

Subscribed and sworn before me this ______day of ________, 19______

_____________________

Notary Public in and for the State of Washington residing at ___________________