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HomeMy WebLinkAbout90100430616 Limited Power of Attorney RECEIVED LINooI_..t,~ COLI,NT'( CLERK (with Durable Provision) 9 0 !'0 (.'~ ,"~ ........................................................................................................................ d 1.!:/~..?v F,I.F ................ D NOTICE: THIS IS AN IMPORTANT DOCUMENT. BEFORE SIGNING THIS OEUMENT, YOU SHOULD KNOW THESE IMPORTANT FARTS. THE PURPOSE OF THIS POW[~ OF ATTORNEY IS TO 61VE THE PERSON WHOM YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOU~ PEOPEET~ WHICH ~AY INCLUDE POWERS TO PLEDGE, SELL OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WI}HOUT ADVANCE ~OIICE TO YOU O~ APPROVAL BY YOU. YOU MAY SPECIFY THAT THESE POWERS WILL EXIST EVEN AFTER YOU BECOME DISABLED, INCAPACITATED OE INCOMPETENT. THIS DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL OR OTHER HEALTH RARE ~EClSlO~S EO~ YOU. IF THERE AUYTHI~6 A~OUI THIS FO~M THA~ YOU DO NOT UNdErSTAND, YOU SHOULD ASK A LAWYE~ TO II TO YOU. YOU MAY ~EVOKE THIS POWE~ OF~EY F YOU LA~E~ WiSH ~0 DO SO. TO AiL PE~SO~S.~it known t~ [ ~ ~.~a as P~y~O hereb~ ~ke and grant a'limited and specific power of attorney and appoint and constitute said individual as my attorney-in-fact. ' - ' My named attorn~y-indact shall have full pow?gL,and authority to undertake, commit and perform only the fol ow ng acts on my behalf to the same extent~i~ad do~ Cerson~ly; all with full power of substitution an~nevo~ation i. th. ~n~: (Describe specific aut~?ty) ~m ~.~. ~/~, tm~ .~ ¢~ ~'a ~,&~ ~ ~ ~'. m ~[ The authority granted shall include such incidental acts as are reasonably ~equi~ed or necessary to carry out and perform the , specific authorities and duties stated or contemplated herein. My attorney-in-fact agrees to accept this appointment subject to its terms, and agrees to act and perform in said fiduciary capacity consistent with my best interests as ray attorney-in-fact deems advisable, and I thereupon ratify all acts so carried out. I agree to reimburse my attorney-in-fact all reasonable costs and expenses incurred in the fulfillment of the duties and responsa bilities enumerated herein. Special durable provisions: This power of attorney Shall not be affected by subsequent incapacity of the Principal. This power of ~ttorney may be revoked by the Principal giving written notice of revocation to the attorney-in-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 Principal resides. Furthermore, upon a finding of incompetence by a court of appropriate jurisdiction, this Power of Attorney shall be irrevocable until such a time as said court determines that I am no longer incompetent. . Other terms: Signed under seal this--(-/7/'~ Signed in the presence of: day of Witness: Witness: ,725 Principal: -" ~.~ i / County of appeared personally known to me (or proved to m~ on t~h'~ basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me that he/~xecuted the same in his/her authorized capacity, and that by his/l(~)ignature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS rny hand and official seal 5 ig n a t ute X... ~------~::~A~ ~~",,~, vv~r~.socrates.cor~ Page 2 © 2004. Socrates Media LLC LF240 * Rev. 04~04