Power of Attorney Form

Introduction

This Power of Attorney is made and entered into on Month Day, Year. I Principal's Nameresiding at Principal's Address, appoint Agent's Name, residing at Agent’s Address, as my Attorney-in-Fact, granting full authority to make decisions and act on my behalf in the matters specified below, effective immediately and lasting until revoked or upon my incapacity.

Agent’s Authority

This Power of Attorney authorizes the named Attorney-in-Fact to handle the matters listed above as if they were the undersigned. The Agent is expected to act in the best interest of the Principal at all times.

Signatures

By signing below, I acknowledge that I understand and agree to the terms of this Power of Attorney.

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