Special
Power
Of Attorney NOTICE: THE POWERS
GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING FOR
SPECIAL POWER OF ATTORNEY. IF YOU HAVE ANY QUESTIONS ABOUT THESE
POWERS, OBTAIN COMPETENT LEGAL ADVICE. THIS DOCUMENT
DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL AND OTHER
HEALTH-CARE DECISIONS FOR YOU. YOU MAY REVOKE THIS
POWER OF ATTORNEY IF YOU LATER WISH TO DO SO.
SPECIAL POWER OF ATTORNEY I, __________, of
__________, hereby appoint __________ of
__________, as my attorney in fact to act in
my capacity to do any and all of the
following: [Describe Specific Authority You
Are Giving To Attorney-In-Fact] The rights,
powers, and authority of my attorney in fact
to exercise any and all of the rights and
powers herein granted shall commence and be in
full force and effect on __________, 20____,
and shall remain in full force and effect
until __________, 20____, or unless
specifically extended or rescinded earlier by
either party. Dated: __________, 20____ By:
__________ STATE OF __________, COUNTY OF
__________ [NOTARIZATION]