I, ________(1)__________, of
________(2)____________, hereby appoint __________(3)____________, of
_________(4)_____________, as my attorney in fact to act in my capacity
to do every act that I may legally do through an attorney in fact. This
power shall be in full force and effect on the date below written and
shall remain in full force and effect until _______(5)____________ or
unless specifically extended or rescinded earlier by either party.
Dated _______(6)____________, 19_(7)__.
____________(8)_______________
STATE OF _________(9)___________
COUNTY OF ________(10)__________
BEFORE ME, the undersigned authority, on this
_(11)_ day of _______(12)_______, 19_(13)_, personally appeared
_______(14)_______________ 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.
_____________(15)____________
NOTARY PUBLIC
My Commission Expires:__(16)__
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.
