KNOW ALL PERSONS BY THESE PRESENTS:
I, ____________________________________ ("Principal") maintaining an address
at _______________________________________________ do hereby make and appoint
________________________________________ ("Agent") maintaining an address at:
_____________________________________________________ my true and lawful
attorney-in-fact for me and in my name, and in my behalf.
My Agent shall have full power and authority to perform any act, power, duty,
legal right or obligation whatsoever that I now have or may later acquire in
connection with or relating to any person, item, transaction, thing,
business, property, real or personal, tangible or intangible, or matter
whatsoever as I could do if personally present. I hereby ratify and confirm
all acts that my Agent, or my Agent's substitute or substitutes, shall
lawfully do or cause to be done by virtue of this power of attorney and the
rights hereby granted. My Agent's powers and authority shall include, but
not be limited to:
1. To conduct, engage in, and transact any and all lawful business
of whatever kind or nature, on my behalf and in my name.
2. To enter into binding contracts on my behalf and to sign,
endorse and execute any written agreement and document necessary to enter
into any such contract and/or agreement, including but not limited to
applications, assignments, bills of sale or lading, bonds, contracts,
covenants, conveyances, deeds, options, trust deeds, security agreements,
leases, mortgages, notes, insurance policies, receipts, title
I may revoke this Power of Attorney at any time by providing written
notice to my Agent.
IN WITNESS WHEREOF, __________________________ (name of Principal) has
executed this Durable Power of Attorney on ____________ (date) at
____________________ (city), __________________________ (state).
________________________________
Signature of ("Principal")
On this day ______________ (date) I declare that the Principal indicated
that he understands the nature of this document and is signing it freely
and voluntarily. Furthermore, the Principal appears to be of sound mind
and does not appear to be under duress.
Witness Signature: ___________________________________
Name: ___________________________________
City: __________________________________
State: ___________________________________
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