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 

ATTORNEY-IN-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)________, 19_(6)_, and shall remain in 

full force and effect until ________(7)________ or unless 

specifically extended or rescinded earlier by either party.  


Dated ___________(8)______________, 19__(9)__.   

SIGNED _________(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)____
1. Your full name
2. County or city in which you reside
3. Full name of person you appoint
4. County or city in which they reside
5. Day and month this becomes effective
6. Year this becomes effective
7. Last day, month and year this is effective
8. Day and month in which you signed it
9. The year in which you signed it
   10. Your full signature
11. The state in which you reside
12. The county in which you reside
FILLED OUT BY NOTARY PUBLIC13. Day you signed the form
14. Month you signed the form
15. Year you signed the form
16. Your full name
17. Notary Public signature
18. Notary Public commission expiration date
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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