TO ALL PERSONS, be it known, that I, __________________________,
the undersigned principal, do hereby grant a general power of
attorney to ________________________ as my attorney-in-fact.
My attorney-in-fact shall have full powers and authority to do
and undertake all acts on my behalf that I could do personally
including but not limited to the right to sell, deed, buy, trade,
lease, mortgage, assign, rent or dispose of any
of my future real or personal property; the right to execute,
accept, undertake, and perform all contracts in my name; the
right to deposit, endorse, or withdraw funds to or from any of
my bank accounts, depositories or safe deposit box; the
right to borrow, lend, invest or reinvest funds on any trms;
the right to initiate, defend, commence or settle legal actions
on my behalf; the right to vote (in person or by proxy) any shares
or beneficial interest in any entity; and the right to retain
any accountant, attorney, physician or other advisor deemed necessary
to protect my interests generally or relative to any foregoing
unlimited power.
My attorney-in-fact hereby accepts this appointment subject to
its terms and agrees to act and perform in said fiduciary capacity
consistent with my best interests as in my attorneys best discretion
deems advisable, and I affirm and ratify all acts undertaken,
This power of attorney may be revoked by me at any time, and
shall automatically be revoked upon my death, provided any person
relying on this power of attorney before or after my death shall
have full rights to accept the authority of my attorney-in-fact
until in receipt of actual notice of revocation.
Signed under seal this day of , 19 .
_______________________________________
STATE OF
COUNTY OF
On ______________ before me,___________________________, personally
appeared __________________, personally known to me (or subscribed
to the within instrument and acknowledged to me that he/she/they
executed the same in his/her/their authorized capacity(ies),
and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted,
executed the instrument.
WITNESS my hand and official seal.
Signature_____________________________
Affiant ____Known ____Unknown
ID Produced____________________
(Seal)
