Fillable Printable Limited Power of Attorney Format

Limited Power of Attorney Format

Limited Power of Attorney

I, _______________________ of ______________ (City), _________________ (State),

appoint _____________________ of ______________(City), _______________ (State),

as my attorney-in-fact to act on my behalf for the purpose(s) of:

____________________________________________________________

This power of attorney starts to be effective on ______________, and shall continue until

_______________. I grant my attorney-in-fact full authority to act in any reasonable and

necessary manner for the purpose of exercising the above powers. I ratify all lawfully

performed acts by my attorney-in-fact in exercising those powers. I agree that any third

party who is given a copy of this power of attorney may act relying on it. I agree that

revocation of this power of attorney is effective as to a third party only upon receipt of

actual notice by the third party. If because of reliance on this power of attorney, a third

party suffers any loss; I agree to indemnify the third party for the loss.

Signed this _______ day of _______________________, _________.

State of ________________________

____________________________________________

Signature of ______________________, Principal

By accepting this appointment and acting under it, the attorney-in-fact (agent) assumes

the legal responsibilities of an agent.

Signature of _______________________, Attorney-in-Fact

Witness the following signature and seal, this _day of ,20 _.

Signature of Principal:

Signature of Appointee:

NOTARY PUBLIC WITNESS

STATE OF: ____________________________ CITY OF , I,

the undersigned, a Notary Public in and for the City and State aforesaid, do certify that

_________________________ whose name is signed to the foregoing Limited Power of

Attorney, bearing date of this day of , 20 , has acknowledged the

same before me in my City and State aforesaid. Given under my hand this day

of , 20 .

Signature:

MY COMMISSION EXPIRES: