Fillable Printable Specific Power of Attorney

Specific Power of Attorney

BE IT ACKNOWLEDGED that I, ___________________________________

Full Name

________________________________, the undersigned, do hereby grant a limited and

social security number

specific power of attorney to _______________________________________________

Full Name

of ___________________________________________________________________

Address Phone

as my attorney-in-fact.

Said attorney-in-fact shall have full power and authority to undertake and perform

only the following acts on my behalf:

1. _______________________________________________________________

2. _______________________________________________________________

3. _______________________________________________________________

The authority herein shall include such incidental acts as are reasonably required to

carry out and perform the specific authorities granted herein.

My attorney-in-fact agrees to accept this appointment subject to its terms, and agrees

to act and perform in said fiduciary capacity consistent with my best interest, as my

attorney-in-fact in its discretion deems advisable.

This power of attorney is effective upon execution. 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 shall have full rights to accept and reply

upon the authority of my attorney-in-fact until in receipt of actual notice of revocation.

Signed this ______________ day of ___________________, 20_____.

___________________________________

Signature