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 _.
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Limited Power of Attorney Format PDF

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