Limited Power of Attorney Sample Form

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RECORDING REQUESTED BY
___________________________
MAIL TO ADDRESS
____________________________
Limited Power of Attorney
I, _______________________ (AKA ________________________ ) 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
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Limited Power of Attorney Sample Form PDF

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