SAMPLE POWER OF ATTORNEY
BY THIS DOCUMENT IT IS HEREBY ACKNOWLEDGED, that I, [[name of person granting power of attorney] of
[city, state], the undersigned, do hereby
grant a limited and specific power of attorney to [name
of person granted power of attorney] of [city,
state] as my attorney-in-fact.
Said attorney-in-fact shall have authority and the power to undertake and
perform only the following acts on my behalf: [list
specific acts the attorney-in-fact is authorized to perform]. This
authority shall also include any incidental acts that are reasonably required to
carry out and perform the specific authorities herein granted.
This power of attorney shall be effective upon execution. This power of
attorney may be revoked by me at any time. This power of attorney shall
automatically be revoked upon my death.
My attorney-in-fact agrees to this appointment subject to its terms. My
attorney-in-fact agrees to act as my fiduciary and in my best interests, as
seems advisable to the best of his discretion.
Signed under seal this [day, e.g. 1st] day
of [month], [year].
______________________________
STATE OF ______________________________
COUNTY OF ______________________________
In _______________, on the _____________ day of ____________, 20___, before
me, a Notary Public in and for the above state and county, personally appeared
[name of person granting power of attorney],
known to me or proved to be the person named in and who executed the foregoing
instrument, and being first duly sworn, such person acknowledged that he or she
executed said instrument for the purposes therein contained as his or her free
and voluntary act and deed.
_______________________________
NOTARY PUBLIC
My Commission Expires: ________
(SEAL)
