<...... broker's name, address, telephone, etc here ......> Date _______________________ To Whom It may Concern; I hereby authorize <........... broker's name ............> to make disbursements, on my behalf, from their Trust account of monies on deposit during the purchase of _______________________________________________ Disbursements may be made by <...... broker's name .......> for the following as indicated by my signature and initials Haulout __________ Marine Survey __________ Engine Survey __________ Yard Bills __________ Registration __________ Sellers funds __________ ______________________________ Purchaser ______________________________ Witness