I, [YOUR FULL NAME], residing at [YOUR ADDRESS], in the state of Kentucky, being of sound mind and understanding the significance of this legal document, do hereby appoint my Agent as follows:

I. Appointment of Agent

Full name of my appointed agent: [AGENT'S FULL NAME], residing at [AGENT'S ADDRESS], is hereby designated as my Attorney-in-fact ("Agent"). I trust in their integrity and capabilities to act in my best interests in all matters pertaining to this Power of Attorney.

II. Effective Date

This power of attorney shall become effective on [EFFECTIVE DATE] and shall remain in full force and effect until [TERMINATION DATE] unless revoked or amended earlier.

III. Powers Granted

My Agent shall have full power and authority to carry out the following duties on my behalf:

• Manage and control all of my financial affairs, including but not limited to banking transactions, investments, and real estate transactions.

• Make decisions regarding my health care, including consenting to or refusing medical treatment, and accessing medical records.

• Represent me in legal proceedings, including the ability to initiate, defend, settle, or compromise any legal actions on my behalf.

• Conduct any other acts necessary to manage and protect my interests, including signing documents, entering into contracts, and accessing information.

IV. Termination

This Power of Attorney shall terminate on [TERMINATION DATE] unless I choose to extend or revoke it before that date. In the event of my incapacity, this Power of Attorney shall remain effective until revoked in writing by my authorized representative.

Signature Section:

In witness whereof, the undersigned parties have executed this Automobile Power of Attorney on [Date].

[YOUR NAME]

[DATE]

[Agent's Name]
[DATE SIGNED]

_____________________________________________________________________________________

Witness Acknowledgement

We, the undersigned witnesses, certify that the vehicle owner has signed this Kentucky Power of Attorney in our presence and that we believe him/her to be of sound mind and under no duress.

Witness 1:

[Witness 1 Printed Name]

[DATE SIGNED]

Witness 2:

[Witness 2 Printed Name]

[DATE SIGNED]

_____________________________________________________________________________________

Notary Acknowledgement

State of Kentucky

County of [County]

On this            day of               in the year                , before me, a Notary Public in and for said County and State, personally appeared [Your Name], known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged that they executed the same for the purposes therein contained.

Witness my hand and official seal.

[Notary Public Name]

My Commission Expires: ____________________________

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