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Home My WebLink About946016 RECORDING REQUESTED BY: . WHEN RECORDED MAil TO: r Name i RECEIVED 3/19/2009 at 10:57 AM RECEIVING # 946016 BOOK: 718 PAGE: 97 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER. WY , . Street Address City State C:Oô097 Zip L J Space above this line for recorder's use WOlCOTTS FORMS INC. WWW.WOlCOTTSFORMS.COM SINCE 1893 Power of Attorney NOTICE: THE POWERS GRANTED BY THIS DOCUMENT MAY BE BROAD AND SWEEPING. THIS DOCUMENT IS NOT INTENDED TO AUTHORIZE ANYONE TO MAKE MEDICAL OR OTHER HEALTH-CARE DECISIONS FOR YOU."IF YOU WISH TO DO SO, FORM #1401 IS DESIGNED FOR THAT PURPOSE. YOU MAY REVOKE THIS POWER OF ATTORNEY IF YOU LATER WISH TO DO SO (FORM #1404). I, 0/ZQ l3pJJp f?oc l- )? 0, eo x ) q I r.h Cf '/ /1 P 'tv ;.J. ? S /'?- "7 NAME AND ADDRESS the undersigned (jeiRtly or 1L9"9r¡lIy, if mgr9 thaFt 81"18) appoint ( ../3'0 ~ oJ n._ /¢ J?.o 0 .l- e P.O,;::So If ¡ 9 I r~cl\ n c~ ~U r¡';?) '2.. 7 NAME AND ADDRESS OF THE PERSON APPOINTED OR OF EACH P SON APPOINTED IF YOU WANT TO DESIGNATE MORE THAN ONE as my agent (attorney-in-fact) to act for me in any lawful way with respect to the following initialed subjects: · Initial options (A) through (0) as appropriate. If you wish to include ALL options, you need only to initial option (P). · If you wish to limit this power of attorney to a specific option or transaction select option (Q) and provide written instructions in the space provided on page 2. . If you select option (R) this becomes a general power of attorney (granting the broadest powers as allowed by law) except those powers that require a specific legal document by law, i.e.: A MedicaLPower of Attorney. INITIAL _(A) _(B) _(C) _(D) _(E) _(F) _(G) _(H) _(I) _(J) _(K) INITIAL Real Property Transactions. _(L) Retirement Plan Transactions. Tangible Personal Property Transactions. _(M) Tax Matters. Stock And Bond Transactions, _(N) Making Gifts To My Spouse, Children, And More Commodity And Option Transactions. Remote Descendants, And Parents, Not To Banking And Other Financial Transactions. Exceed In The Aggregate $10,000 To Each Of Business Operating Transactions. Such Persons In Any Year. Insurance And Annuity Transactions. _(0) Full And Unqualified Authority To My Attorney(S)- Estate, Trust, And Other Beneficiary Transactions In-Fact To Delegate Any Or All Of The Foregoing Claims And Litigation. Powers To Any Person Or Persons Whom My Personal And Family Maintenance. Attorney(S)-ln-Fact Shall Select. Benefits From Social Security, Medicare, _(P) ALL THE POWERS LISTED ABOVE. Medicaid Or Other Governmental Programs Or _(Q) ONLY THE POWERS SPECIFIED IN SPECIAL Civil Or Military Service. INSTRUCTIONS ON TOP OF PAGE 2. .~I... (R) ALL POWERS EXCEPT MEDICAL (GENERAL POWER OF ATTORNEY) YOU NEED NOT INITIAL ANY OTHER OPTIONS IF YOU INITIAL OPTION (P) or (Q) or (R). :iÎ'~iJlJ~ij[ CLASS 04 #1410 REV. 5-04 . · Wolcotts Forms, our resellers and agents make no representations or warranty, express or Implied, as to the fitness of this form for any specific use or purpose. If you have any question, it is always best to consult a qualified attorney before using this or any legal document. SPI:C'I)~lfi~TR.UCTIONS: . .r· ÜOô098 On the following lines you may give special instructions limiting or extending the powers granted to your agent. NO((.f)¡Tt"J.s.rAtJPIN& AWY ~t. PIl..tÑÚ ,ðAJ of /1;1IIIf&. Dr ItrrMN~ J4A/ t+6tNÌ- A.4Af ~ ,,¡j INY I/J¡J. UÞM 'I ~r H~ ~lk j)1JtI1/i1t T'B ",.".,. I AI ,wy A.\1t~ /GVrrl;" 1Þ ,¡C.f Y PM ILy "f1I.u.~r:: ",.--' VJ!, I TO INDICATE WHEN THIS DOCUMENT SHALL BECOME EFFECTIVE, INITIAL ONE OF THE FOLLOWING: \i' ~ ~ (A) This document shall become effective upon the date of my signature, (B) This document shall become effective on DATE (C) This document shall become effective upon the date of my disability and shall not otherwise be affected by my disability, (Springing) INITIAL ONE OF THE FOLLOWING ONLY, IF YOU HAVE INITIALED (A) OR (B) ABOVE: J. n This document shall not be affected by my subsequent disability, (Durable) This document shall be revoked by my subsequent disability, (Non-Durable) IF YOU WANT TO LIMIT THE T~RM OF THIS DOCUMENT, INITIAL ONE OF THE FOLLOWING: This document shall only continue in effect for 0 years or 0 months. (Limited) This document shall terminate on . (Limited) DATE IF I HAVE INITIALED OPTION (C) AND I HAVE BECOME INCAPACITATED, DURING THE TERM OF THIS DOCUMENT, THE TIME LlMJATJONS ABOVE SHALL BE NULL AND VOID. UNLESS YOU DIRECT OTHERWISE ABOVE, THIS POWER OF ATTORNEY IS EFFECTIVE IMMEDIATELY AND WILL CONTINUE UNTIL IT IS REVOKED If either of the Durable or Springing paragraphs are initialed then the NOTICE TO PERSONS EXECUTING DURABLE POWER OF ATTORNEY below applies. NOTICE TO PERSON EXECUTING DURABLE POWER OF ATTORNEY A durable power of attorney is an important legal document. By signing the durable power of attorney, you are authorizing another person to act for you, the principal. Before you sign this durable power of attorney, you should know these important facts: Your agent (attorney-in-fact) has no duty to act unless you and your agent agree otherwise in writing. This document gives your agent the powers to manage, dispose of, sell, and convey your real and personal property, and to use your property as security if your agent borrows money on your behalf. This document does not give your agent the power to accept or receive any of your property, in trust or otherwise, as a gift, unless you specifically .authorize the agent to accept or receive a gift. Your agent will have the right to receive reasonable payment for services provided under this durable power of attorney unless you provide otherwise in this power of attorney. The powers you give your agent will continue to exist for your entire lifetime, unless you state that the durable power of attorney will last for a shorter period of time or unless you otherwise terminate the durable power of attorney. The powers you give your agent in this durable power of attorney will continue to exist even if you can no longer make your own decisions respecting the management of your property. You can amend or change this durable power of attorney only by executing a new durable power of attorney or by executing an amendment through the same formalities as an original. You have the right to revoke or terminate this durable power of attorney at any time, so long as you are competent. This durable power of attorney must be dated and must be acknowledged before a notary public or .signed by two witnesses. If it is signed by two witnesses, they must witness either (1) the signing of the power of attorney or (2) the principal's signing or acknowledgment of his or her signature. A durable power of attorney that may affect real property should be acknowledged before a notary public so that it may easily be recorded. You should read this durable power of attorney carefully. When effective, this durable power of attorney will give your agent the right to deal with property that you now have or might acquire in the future. The durable power of attorney is important to you. If you do not understand the durable power of attorney, or any provision of it, then you should obtain the assistance of an attorney or other qualified person. Page 2 of 4 F IF YOÚ HAVE APPOINTED MORE THAN ONE AGENT, CHECK ON OF THE FOLLOWING: (::J Each agent may exercise the powers conferred separately, without the consent of any other agent. . (::J All agents shall exercise the powers conferred jointly, with the consent of all other agents, You MAY D GNATE AN ALTERNATE AGENT (ATTORNEY-IN-FACT). ANY RNATE YOU DESIGNATE WILL BE ABLE TO EXERC THE SAME POWERS AS THE AGENT(S) YOU NAM T THE BEGINNING OF THIS DOCUMENT. IF YOU WISH TO DES ATE AN.ALTERNATE OR ALTERNATES PLETE THE FOLLOWING: If the agent(s) named at the inning of this document is u e or unwilling to serve or continue to serve, then I appoint the following agent to serve with 000099 ,,,,,r. I agree that any third party "Yho receives a copy of this document may act u r it. Revocation of the power of attorney is not effective as to a third party until the third party has actual knowledge of the re cation, I agree to indemnify the third party for any claims that arise against the third party because of reliance on this power 0 orney, day of h-:?1 0 n... ~~ ~ , - Signed this , :;z CJO '1 , ? y ~'I?dJ ~ ~R'7 AUTOGRAPH SOCIAL SECURITY NUMBER .~ State of UJ Y ø M ( J\j(7 County of _L tJ CO l..~ BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES OF AN AGENT NOTICE TO PERSON ACCEPTING THE APPOINTMENT AS AGENT By acting or agreeing to act as the agent (attorney-in-fact) under this power of attorney you assume the fiduciary and other legal responsibilities of an agent. These responsibilities include: 1. The legal duty to act solely in the interest of the principal and to avoid conflicts of interest. 2. The legal duty to keep the principal's property separate and distinct from any other property owned or controlled by you. You may not transfer the principal's property to yourself without full and adequate consid@!!tion or accept a gift of the principal's property unless this power of attorney specifically authorizes you to transfer property to yourself or accept a gift of the principal's property. If you transfer the principal's property to yourself without specific authorization in the power of attorn\,y, you may be prosecuted for fraud and/or embezzlement. If the principal is 65 years of age or older at the time that the property is transferred to you without authority, you may also be prosecuted for elder abuse under applicable state law. In addition to criminal prosecution, you may also be sued in civil court, l!We have read the foregoing notice and l!We understand the legal and fiduciary duties that l!We assume by acting or agreeing to act as the agent(s) (attorney-in-fact) under the terms of this power of attorney. Date: ~tfæ.~- t:. b ;2C1ð7 Date: PRINT NAME OF AGENT AUTOGRAPH OF AGENT Page 3 of 4 f:Oô1.00 CERTIFICATE OF ACKNOWLEDGEMENT OF NOTARY PUBLIC Individual STATEOF -¥lY2:1? COUNTY OF ,. (' / 11 . \...- }ss. On Ihl~ §, of "If!::..~ h In tho yo., 2tJIJt before mo. /.....ú. . D , a Notary Public, duly commissioned a ~qUalified in ab~e said County and State, personally appeared Vl!..>ro...l3 ð/.j+ , LJ"þersonally known to me or 0 proved to me on this basis of satisfactory evidence consisting of an identifying document or o the oath of to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that h~/she/they executed the same in hislher/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the same. ·-~1 ~öTÃRYPUBUC: LUANN EPPLER 51il,TE OF COUNTY OF WYOMING LINCOLN -'011 \: " .,"" "'~¡>\RtSMII.RCI!:~::.~ \\._.,__~~"i/ "~~~~i'~:;;}:~~·:~i.:;~:~~~~'· ~ond~Ã:> .' A OGRAPH Seal OR WITNESSES We declare under penalty of perjury under the laws of the State of that the person who signed or acknowledged this document is personally ~nown to us (or proved to us on the basis of convincing evidence) to be the principal who signed or acknowledgêd this power of attorney in our presence. Executed this day of WITNESS WITNESS ADDRESS ADDRESS CITY , STATE AND ZIP CITY, STATE AND ZIP Page 4 of 4