Specific Power of Attorney
BE IT ACKNOWLEDGED that I, ___________________________________
________________________________, the undersigned, do hereby grant a limited and
social security number
specific power of attorney to _______________________________________________
as my attorney-in-fact.
Said attorney-in-fact shall have full power and authority to undertake and perform
only the following acts on my behalf:
The authority herein shall include such incidental acts as are reasonably required to
carry out and perform the specific authorities granted herein.
My attorney-in-fact agrees to accept this appointment subject to its terms, and agrees
to act and perform in said fiduciary capacity consistent with my best interest, as my
attorney-in-fact in its discretion deems advisable.
This power of attorney is effective upon execution. This power of attorney may be
revoked by me at any time, and shall automatically be revoked upon my death, provided
any person relying on this power of attorney shall have full rights to accept and reply
upon the authority of my attorney-in-fact until in receipt of actual notice of revocation.
Signed this ______________ day of ___________________, 20_____.