HomeMy WebLinkAbout894489 ST/~TUTORY POWER OF A~ORNEY JEANNE
NOTICE: The Powers granted by this do~ment are broad and sweeping. They ~re "
explained in the Uniform Statulo~ Form Power of Attorney Act. If you have any
questions about these powers, obtain ~mpetent legal advi~. This document
authorizes your Attorney in Fact to make medi~l and other health ~re decisions for
you. You may rev°ke this Power of Attorney if you later wish to do so,.
You may have other rights or powers under Colorado law not contained in this form.'
I, William E. Goss, a/k/a Gene Goss, of Colorado Springs, Colorado, appoint Donna N:
Zorn, Route 5, Box 200, Great Bend, KS, 67530 and Duane Goss, Box 1914, Rivedon,
, .-.-,~,.,,, ns my agents (/\ttcrney in Fsct) to act for me in any lawful way with respect
to the following initialed subjects:
To grant one or more of the following powers, initial the line in front of each
power you are granting.
To withhold a power, do not initial the line in front of it. You may, but need not,
cr. oss out each power withheld.
/¢/,-Z'.,~. (A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(K)
(L) .
(M)
Real property transactions (including any and all transactions with
respect to 2445 Gina Drive, Colorado Springs, CO 80916).
Tangible personal property tranSactions.
Stock and bond transactions.
C°mmodity and option transactions.
Banking and other financial institution transactions. (Including
transactions with Security Service FCU)
BuSiness operating transactions.
Insurance and annuity transactions.
Estate, trust and other beneficiary transactions.
Claims and litigation.
Personal and family maintenance.
Benefits from Social Security, Medicare, Medicaid, or other
governmental programs, or military service.
Retirement plan transactions.
Tax matters.
SPECIAL INSTRUCTIONS
Either of my attorneys in fact may exercise any or all of the above powers without the
signature of the other attorney in fact.
697
This Power of Attorney specifically gives the power to authorize any and all medical
and hospital care or treatment, including major surgery, deemed necessary by duly
qualified health care providers and physicians at any hospital, clinic, or comparable
facility, for my health and well-being.
This Power of Attorney is durable and will continue to be effective even though I
become disabled, incapacitated, or incompetent.
I agree that any third party who receives a copy of this document may act under it.
Revocation of the Power of Attorney is not effective as to a third party until the third
party learns of the revocation. I agree to indemnify the third party for any claims that
arise against the third Party because of reliance on this Power of Attorney.
SIGNED.thiS :.. ]__.~._ day. of ¢,40vemb, e~; -,~ 999.
William E. Goss, a/~a Gene Goss-
Social Security Number
STATE OF COLORADO )
) ss
COUNTY OF EL PASO )
This document was acknowledged before me on this ! ?'7~ day of November 1999 by
William E. Goss, a/k/a Gene Goss. Witness my hand and official seal.
My Commission Expires
02/06/2002
: P'I~ClMEN SIGNATURE OF AGENTS:
Donna ~. Zorn
Duan~ Goss
Notary ~ubli(~'
320 E. CoStilla
Colorado Springs, CO