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Lasting Power of Attorney Form

The Lasting Power of Attorney replaces an Enduring Power of Attorney effective September 2007. However, any Enduring Power of Attorney created before that date remains valid.







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Lasting Power of Attorney

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Lasting Power of Attorney


Date ____/____/______

I [Legal Name]

A resident of [City][State]

Located at [Address]

[City], [State] [Zip Code]

Appoint [Legal Name]

A resident of [City][State]

Located at [Address]

[City], [State] [Zip Code]

As my attorney-in-fact to act on my behalf for the following lasting purpose of:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

This power of attorney shall take effect on ___/___/____, and will continue indefinitely or until revoked by me. I do hereby grant my attorney in fact complete authority to act in any reasonable manner that is necessary to execute the above mentioned powers that are granted.

I agree that any third party who is given a copy of this power of attorney may act relying on it. I also 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. I agree to indemnify the third party for any loss that may be suffered while carrying out this power of attorney.

This contract shall be governed by the laws of the State of __________ in __________ County and any applicable Federal Law.


__________________________________________________________ Date____________
Signature


By accepting this appointment and acting under it, I the attorney-in-fact (“Agent”) do hereby assume the legal responsibilities of an agent.


_____________________________________________________________________Date____________
Signature of Attorney-in-Fact


WITNESS #1) _________________________________


WITNESS #2) _________________________________










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