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Special Power of Attorney Form

A Special Power of Attorney is usually used to give an Agent the legal ability to handle certain specific situations for you when you are unable or unavailable to execute.

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Special Power of Attorney

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Special Power of Attorney

Date ____/____/______

I, do hereby [Legal Name]

A resident of [City][State]

Located at [Address]

[City], [State] [Zip Code]

Do Hereby Appoint [Legal Name]

A resident of [City][State]

Located at [Address]

[City], [State] [Zip Code]

As my attorney-in-fact to make the following specific decisions for me:

_________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________

This Special Power of Attorney is to start to be effective on ____/____/______, and shall remain effective until ____/____/______.

I do hereby grant my attorney-in-fact complete and full authority to act in any reasonable and necessary manner for the purpose of exercising the above mentioned powers. I also, ratify all the lawfully performed acts by my attorney-in-fact in exercising those powers.

I fully understand and agree that any third party who is given a copy of this Special Power of Attorney may act relying on it. I also, agree that revocation of this Special Power of Attorney is effective as to a third party only when they receive receipt of an actual notice by the third party. If due to reliance on the Special Power of Attorney, a third party suffers any loss, I agree to pay for any third party loss.

I sign my name to this Special Power of Attorney on:

____________ Day of ____________ Month ____________ Year


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

Signature of Attorney-in-Fact

WITNESS #1) _________________________________

WITNESS #2) _________________________________

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