Limited (Special) Power of Attorney
Date:
I, (Full Name of Principal):
Address:
hereby appoint (Full Name of Attorney-in-Fact):
Address of Attorney-in-Fact:
to act for me specifically and only for the following purposes:
Additional Limitations or Instructions:
This power of attorney shall be effective on:
and will expire on:
IN WITNESS WHEREOF, I have hereunto set my hand this day:
Principal's Signature
Attorney-in-Fact's Signature
Acknowledgment (Optional, for Notary)
State of:
County of:
On this ___ day of __________, 20____, before me personally appeared:
Notary Public: