SPECIAL POWER OF ATTORNEY

SPECIAL POWER OF ATTORNEY

I, ___________(1)___________, of __________(2)_________, hereby appoint

______________(3)________________ of ___________(4)_______________, as my attorney

in fact to act in my capacity to do any and all of the following:

(DESCRIBE THE EXTENT OF AUTHORITY YOU ARE GIVING TO YOUR ATTORNEYIN-

FACT)

The rights, powers, and authority of my attorney in fact to exercise any and all of the

rights and powers herein granted shall commence and be in full force and effect on

____________(5)_______, ____(6)_, and shall remain in full force and effect until ___________

(7)_______________ or unless specifically extended or rescinded earlier by either party.

Dated ___________(8)______________, ____(9)_.

____________(10)______________

STATE OF _______(11)____________

COUNTY OF ______(12)____________

BEFORE ME, the undersigned authority, on this _(13)_ day of _______(14)________, 19

_(15)_, personally appeared ___________(16)___________ to me well known to be the person

described in and who signed the Foregoing, and acknowledged to me that he executed the same

freely and voluntarily for the uses and purposes therein expressed.

WITNESS my hand and official seal the date aforesaid.

_________(17)___________________

NOTARY PUBLIC

My Commission Expires:__(18)____

NOTICE

The information in this document is designed to provide an outline that you can follow

when formulating business or personal plans. Due to the variances of many local, city, county

and state laws, we recommend that you seek professional legal counseling before entering into

any contract or agreement.


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