Special Power of Attorney
I, {{full_name ? full_name : '__________________________'}} (“Declarant”), residing at {{declarantAddress ? declarantAddress : '__________________________'}}, hereby appoint {{agent_name ? agent_name : '__________________________'}} residing at {{agentAddress ? agentAddress : '__________________________'}}, as my Attorney-in- Fact ("Agent") to act in my capacity to do any and all of the following:
{{agent_authority ? agent_authority : '(EXTENT OF AUTHORITY YOU ARE GIVING TO YOUR ATTORNEY-IN-FACT)'}}
The rights, powers, and authority of my Agent to exercise any and all of the rights and powers herein granted shall commence and be in full force and effect on _______________, 20__, and shall remain in full force and effect until ______________, 20__, or unless specifically extended or rescinded earlier by either party.
_____________________________________ Date: _____________________
{{full_name ? full_name : '_____________________________________'}} (Signature)
Declarant Full Legal Name: {{full_name ? full_name : '__________________________'}}
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First Witness Signature
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First Witness Printed Name
_____________________________________
Date
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First Witness Address
_____________________________________
First Witness City, State, Zip
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Second Witness Signature
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Second Witness Printed Name
_____________________________________
Date
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Second Witness Address
_____________________________________
Second Witness City, State, Zip
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Notarization:
The foregoing instrument was acknowledged before me on ______________, by Claimant, _______________, who is personally known to me or who has produced _________________ as identification.
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Signature of Notary taking acknowledgment
Date of Expiration: _____________________
