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· Real estate transactions
~afi~,ilSl~ fSfi~s6fi/~l ~5i:6~i4y t/ansactions
Bond, shai:e and commodity 'transactions
Banking transactions
Business operating transactions
Insurance transactions
Gifts to charities and individuals other than Att0mey-in-Fact
(If trust distributions are involved or tax consequences are anticipated, consult an attorney.)
C-l~ims~nd~-li~iffarien~ - - :'
Personal relationships and affairs
DURABLE POWER OF ATTORNEY
NOTICE: ]'HIS IS AN IMPORTANT DOCUMENT. BEFORE SIGNING THIS.
DOCU1MENT, YOU SHOULD .KNOW THESE ~,IZORTANT FACTS. THE PURPOSE OF
THIS.POWER OF ATTORNEY' IS TO GYVE TIF~E PERSON 55rHObl YOU DESIGNATE
(YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY
h~CLUDE POWERS TO PLEDGE, SELL OR OTHERwisE DISPOSE OF ANY REAL
UR PERSONAL PROPERTY wITHOUT ADVANCE NOTICE TO YOU OR APPROVAL
BY YOU. YOU MAY spEcIFY THAT THESE POWERS WD~L EXIST EYEN AFTER
¥O11 g~,COME DISABLED, INCAPACITATED OR INCOMPETENT. THIS
DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE 1VIEDICAL OR OTHER
HEALTH CARE DECISIONS FOR YOU. IF THERE IS ANYTHING ABOUT THiS
· OPu¥1 ~n~x~t YOU DO NOT UNDERS'FAND, YOU SHOULD ASK A LA~VYER TO
EXPLAIN IT TO YOU..YOU MAY REVOKE T]~HS POWER oF .ATTORNEY IZ' YOU
TO .ALL PERSONs, b~ it known that I, ,/~r)dJ F')e' Z ,'
0 f ~~J /J J' ffZ~ ' '~ I ' 't l] ~ undersiAned Grantor[
do hereby make and grant a =efieral power of attomey to d/e/9/'7< E ,~/~/y,4/'~_ff ~__-
tute and appoint said mdividu~ as my attorney-in-fact.
My attorney-in-fact shall act in my name, place and stead in' any way winch I ~yself could do, if I were
personally present, with respect to the following matters, to the extent that I am pelmitted by law to act through :an agent:
(NOTICE: The grantor must write his or her i~itials '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 ~ve the agent authority. If the
blank space ~vithin a box for any particular subdivision is NOT initialed, NO AUTHORITY WILLBE GRANTED
for matters that are included in that subdivision. Cross out each power withheld.)
[ ]
[ ~ 40.]
(J) Benefits from military service ,~xt~a, ,~ ,-s-,~
(K) Records, repons and statements .,
(L) Full and unqualified authority to my attorney-in-fact to delegate any or, all of the foregoing
powers to any person or persons whom my attorney-in-fact shall select
(M) A~ccess to safe deposit box(es)
(N) All other matters
Durable Provision:
(O) If the blank space in the block to the left is initialed by the Grantor, ttfis power of attor-
ney shall not be affected by the subsequent disability or incompetence of the Grantor.
Other Terms:
My attorney-in-fact hereby accepts this appointment Subject to its terms and-agrees to act and
perforn~ in said fiduciary caPacity consistent with my best interests as he/she in his&er best
:) discretion deems advisable, and I affirm and ratify all acts so'undertaken.
TO INDUCE ANY THIRD PARTY TO ACT HEREUNDER, I HEREBY AGREE THAT ANY
'THIRD PARTY RECEIVING A DULY EXECUTED COPY OR FACSIMILE OF THIS
· [NSTRUIVlENT MAY' ACT HEREUNDER, AND THAT REVOCATION OR TERMINATION
'HEREOF SHALL BE INEFFECTIVE AS TO SUCH THIRD PARTY UNLESS AND UNTIL
ACTUAL NOTICE OR KNOWLEDGE OF SUCH REVOCATION OR TERMINATION
HAVE BEEN .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 ,~ND ALL CLAIMS THAT MAY .ARiSE AGAINST SUCH THIRD
PARTY BY REASON OF such THIRD PARTY H~SVIIqG RELIED ON'THE PROVISIONS
OF THIS INSTRUMENT.
Signed in the presence of:
· witness
State of
/ Xt~;~ey-in-Fact . !
On ~-/2~;~OO_.~ beforeme, /~) ~ ~2~
. . - , 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
acknowledged to me that he/she/they executed the same in his/hir/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 file person(s) acted,
executed the instrument.
WITNESS my hand and official
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020
ATTACHMENT TO DURABLE POWER OF ATTORNEY - ATTORNEY IN FACT
STATE OF ~ /._ /..~ ~oo ~ ~
COUNTY
On ihis I I day of q~ E. P'T' 9_ ~, ~[C: Zo 03 persdnolly appeared before
me, (o Notary of Public), G b,f_~om C- t~-z),z~p~_ knownto
Me, or has provided sufficient and valid idenfiiicatJon, and who has signed and
execuled the foregoing document in my presence, under her own tree will.
WITNESS my hand and official seal,
My commission expires
Signed, C.x~, ~
Nofary Public
Residing al: ~ 0~'
Cp ~,-0 lo-.o-7
Type of I.D. :zz/., Dp-.i c~ ~ r~