HomeMy WebLinkAbout875091LF240-04
LIMITED POWER OF ATTORNEY
(With Durable Provision)
NOTICE: THIS IS AN IMPORTANT DOCUMENT. BF_,FORE SIGNING TItlS
D " i'
OCUMLNT, YOU SHOULD KNOW THkSE IMPORTANT FACTS. TIlE PURPOSE OF
TttIS POWER OF ATTO~EY IS TO GIVE THE PERSON WHOM YOU DESIGNATE
(YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY
INCLUDE POWERS TO ~
PLEDGE~ SELL OR OT~RWISE DISPOSE OF ANY REAL OR
PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY
YOU. YOu MAY SPECIFY THAT THESE POWERS WILL EXIST EVEN AFTER YOU
BECOME DISABLED, INCAPACTI~TED OR INCOMPEIENF.~ r~r ~ THIS DOCUMENT
DOES NOT AUTItORIZE ANYONE TO MAKE MEDICAL OR OTHER HEAUFH CARE
DECISIONS FOR YOU. IF THEI~ IS ANYTHING ABOUT THIS FORM THAT YOU DO
NOT UNDERSI~NI), YOU SHOULD ASK A LAWYER TO EXPLAIN IT TO YOU. YOU
MAY ~VOKE THIS POWER OF ATTORNEY IF YOU LATER WISH TO DO SO.
TO AbL IE~8ONS,,,ba it known, that I,
9rantor, do hereby make ami ~ant a Iimited and specific power of attorney to
and appoint and constitute said individual as my attorney-in-fact.
My named attomeydn-fact shalI have full power and authority to undertake, commit and perR)rm only
the following acts on my behalf to the same extent as if I had done so personally; ali with full power of
substitution and revocation in the presence: (Describe specific authority)
The authority granted shall include such incictental acts as are reaso~lably reqLdred or llecessary to carry
out and perform the specific authorities and duties stated or contemplated herein.
My attorney-in-fact agrees to accept this appointment stlt~ject to its terms, and agrees to act and perfornl
in said fiduciary capacity COllSiStellt with ~ny best interests as my altorlley-itl-fact deems advisable, and
thereupon ratify all acts so carried out.
I agree to reinlburse I1ly attorney-ill<fact all reasoilab]e costs and expeIlses incurred ill the
the chities and responsibilities enumerated herehl.
~ 1992-2001 E*Z LegM Forms, Inc. Page
Rev, 03/01
Tilts product does not collstitute tile rendering Df legal advice or services. This product is hltellded for i~formatJollal ilSe ollly alld is liar a siibMitute for legal
advice. Sta~e laws vary, so consul/an attorney un all legal matters. This product was riel necessarily prepared by a pers(m licensed to practice law in your state,
~p '
ecml durable ' '
prows~ons:
This power of attorney shall not be affected by subsequent incapacity of the Grantor~ This power of
attorney may be revoked by the Grantor giving written notice of revocation to the attorneyqn-fact,
provided that any party relying in good faith upon this power of attorney shall be protected unless and
until said party has either a) actual or constructive notice of revocation, or b) upon recording of said
revocation in the public records where the Grantor resides.
Other terms
Signed in the presence of:
Witness
W~tness Attorney-in-Fact
Witness
Witness
State of
County of
Ou ~ ~x ~ ~ - ~oO t before~e,
appeared -o I~ ~m ~_~ ~ '
personally known to me (o~ proved to me on the basis of satisfactory evidence) to be the person(s)
whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they
executed the same in his/her/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 instrument.
WITNESS my hand and official seal.
. Affiant Known ~_Produced ID
Typ - '.
State of
County of
On before me,
appeared
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s)
whose name(s) is/are subscribed to the within instrument and achmwledged to me that he/she/they
executed the same in his/her/their authorized capacity(les), 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 instrument.
WITNESS my hand and official seal.
Signature
Affian~~own Produced ID
Type of ID
(Seal)
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