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HomeMy WebLinkAbout889745 RECEIVED LINCOLN COU/'4Ty CLERK ,BOOK~q PRPAGE 8 0 9 A205-10 R205-04 GENERAL POWER OF ATTORNEY ................ (With Durable Provision) NOTICE: THIS IS'AN IMPORTANT DOCUMENT. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS. THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON WHOM YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO PLEDGE, SELL OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROP- ERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. YOU MAY SPECIFY THAT THESE POWERS WILL EXIST EVEN AFTER gfOU BECOME DIS- ABLED, INCAPACITATED OR INCOMPETENT. THIS DOCUMENT DOES NOT AUTHO- RIZE ANYONE TO MAKE MEDICAL OR OTHER HEALTH CARE DECISIONS FOR YOU. IF THERE IS ANYTItING ABOUT THIS FORM THAT YOU DO NOT UNDER- STAND, YOU SHOULD ASK A LAWYER TO EXPLAIN IT TO YOU. YOU MAY REVOKE THIS POWER OF ATTORNEY IF YOU LATER WISI-J. TO DO SO. tJ TO ALL P~E]RSOi~S,,be iJ~,k..nown th.at.l,. (~, C. I{/Y} fYl~ ~-' , tM undersigned Grantor, d9 hereby make and grant a gen,eral power of attorney to and do ther~uP0~n__cp~nst!tute and appoint said indMS'ual as,~ ~fioraey-in-fac~agent. My attorneyiin-fact/agent shall act in ~ny name, place and stead in any way which I myself could do, if I were personally present, with respect to the following matters, tO the extent that I am permitted by law to act through an agent: (NOTICE: The grantor must write his or her initials in the corresponding blank space of a' box below with respect to each of the subdivisions (A) through (O) below for which the Grantor wants .to give the agent authority. If the blank space within a box for any particular subdivision is NOT initialed, NO AUTHORITY WILL BE GRANTED for mat- ters that are included in that subdivision. Cross out each power withheld.) [ ] (c) [,Z3[Z T-]' (D) [ ] (E) [ ] (F) [ ] (G) [ ] (H) Real estate transactions Tangible personal property trausactions Bond, share and commodity transact'ions Banking transactions Business operating transactions , Insurance transactions Gifts to charities and indiv'iduals o{her than Attorney-in-Fact/Agent (Il' trust distributions are involved or tax consequences are anticipated, consult an attorney.) Claims and litigation © 1992-2000 E-Z Legal Forms. Inc. ._~:. ~.,'. ,~, ;-~ ~;~.~,, .,..~:..,,.?T,,,;~ , Rev. 6100 Th s p'oducl does not constitute the rendering of leg-~l advice or services. This produgt is.int,er~df,:~ .for: i',n_formatiomil}'~se .P,~l~i~g,d,'~ig'h_0t!a substitute for legal adv ce State aws vary so consu t an attorney on all legal matters Th s product was.noi hecessari'ly, prepared by a person' |l~,~i{g~:i.l'..{~ ~i-hdtice law m this state. . , . .............. ....... :~:.,~_' ...... ,- --,.~ ............. ..:: _ ~ J'.~/'~%,&.*r.: l .L ~ ....................... ...................................................................................... ' -*;: ~? :.;. ~ ,'.' ...... V,. ', .i;~L~, ici ~ If your state requires 8 '/~" x 11" forms, cut off line bottom of. this;page at the dottcd..line. 5} ",'F' ~ ii.' '-i:~ f~'~ 7- ........... [ 1 [ ] [.~.~V~ [ ] [ ] [ ] (I) Personal relationships and affairs (J) Benefits from ~nilitary service (K) Records, reports and statements (L) Full and unqualified authority to my attorney-in-fact/agent to delegate any or all of the fore- going powers to any person or persons whom my attorney-in-fact/agent shall select (M) Access to safe deposit box(es) (N) To authorize medical and surgical p[pce, dures (Peunsylvania only) (O) All other matters Durable Provision: (P) If tbe blank space in the block io tile left is initialed by tim Grantor, this po~ver of attor- ney shall not be affected by the subsequent disability or incompetence of tim Grantor. (~tne~ Terms: .. 7 ., -.. :.i_ My attorney-in-fact/agent hereby accepts tiffs appointinent subject to its terms and agrees to act and perform in said fiduciary capacity consistent with my best interests as he/she in his/her best discretion deems ad./isable, and I affirm and ratify all acts so undertaken. TO INDUCE ANY FHIRD PARTY TO ACT HEREUNDER, I HEREBY AGREE THAT ANY THIRD PARTY F ECEIVING A DULY EXECUTED COPY OR FACSIMILE OF THIS INSTRUMENT M. 'kY ACT HEREUNDER, AND THAT REVOCATION OR TERMINATION HEREOF SHALL 3E INEFFECTIVE AS TO SUCH THIRD PARTY UNLESS AND UNTIL ACTUAL NOTICi~ OR KNOWLEDGE O? SUCH REVOCATION OR TERMINATION SHALL HAVE B~ SN RECEIVED BY SUCH THIRD PARTY, AND-I FOR MYSELF AND FOR MY HEIRS, .EXECUTORS, LEGAL REPRESENTATIVES AND ASSIGNS, HEREBY AGREE TO INDEMNIFY AND HOLD HARMLESS ANY SUCH THIRD PARTY FROM AND AGAINST ANY AND ALL CLAIMS THAT MAY ARISE AGAINST SUCH THIRD PARTY BY REASON OF SUCH THIRD PARTY HAVING RELIED ON THE PROVISIONS OF THIS INSTRUMENT. Signed under S':,(i ~his ' day'[3~- ........~- - ' (year). Signed in the presence ~ f: it n ~-'~-,//I/'fl (-~"""~' - '/[ '/ Grantor Attorney-in-'Fhcff"A~ent State of G4-~F~4- [ff } County of~Ad.T d.:./4_l/~d:- ./r~ACt41t* c/-tt~c TI/M/t4Ae-d--t(. On ~/C /~ ~Z~d~ bef0reme, , ,appeared , personally known to me (or proved to ~ne ,,n the basis of satishctory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument ard acknowledged to me that he/she/they executed the same in his/her/their authorized capac- ity(ies), and that by his/aer/their signature(s) on the insffulnent the person(s), or tlie entity npon behalf of which the person(s) acted, executed the instrument. WITNESS my hand an.. official seal. Signature Affiant Known K/- Produced ID (Seal) ( NOTARY PUI~LiC ~ Type of ID Raymond'A. MartlnezJ ~0305South 1300Eeat ..-I ........ Sa n ~/y; t. Jta h - 8 a'og4- ....... I ....................................................... 7"'7-"7-5.- ........................... Comml~elon Expires x~s~'r~ ^pr, ao, ~oos ! STATE OF UTAH