[OPTIONAL] Section 4. Delegation of Powers. The Agent may delegate the powers granted to
the Agent by this Power of Attorney by a delegation in writing which makes reference to this Power of
Attorney and otherwise complies with applicable law.
[OPTIONAL] Section 5. Transfer/Gift to Agent
. This Power of Attorney specifically
authorizes the agent to convey the property described in this Power of Attorney to the Agent [for nominal
consideration, as a gift /or/ for a valuable consideration]. _______ Initials of Principal. [NOTE:
Without the initials of the Principal on the preceding line, this Section of this Power of Attorney shall not
[OPTIONAL] Section 6. Skills and Expertise of Agent
. I/we selected the Agent for his/her
special skills and expertise in [describe special skills and expertise]. _______ Initials of Principal.
[NOTE: Without the initials of the Principal on the preceding line, this Section of this Power of Attorney
shall not be effective]
In witness whereof, the Principal has executed this instrument this ____ day of ______, 2002.
Print Name: __________________________________
Affirmation by Witness
I, ____________________ witnessed the signature
of this Power of Attorney by the Principal, and I
affirm that the Principal appeared to me to be of
sound mind, was not under duress, and the Principal
affirmed to me that he/she was aware of the nature of
this Power of Attorney and signed it freely and
Print Name: ___________________________
Acknowledgment by Principal
(NOTE: If power of attorney is effective for 90
days or less, then witness and notary may be the
State of ______________________
County of ____________________, S.S.
At ____________________________, in
said County and State, personally appeared
___________________________ the Principal,
who is known to me or was otherwise suitably
identified, did acknowledge to me that the
execution of this Power of Attorney was his/her
free act and deed.
Print Name __________________________
Acceptance by Agent