New Hampshire Limited Power of Attorney for Stock Transactions and Corporate Powers

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New Hampshire Limited Power of Attorney for Stock Transactions and Corporate Powers Powered By Docstoc
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                             This Limited Power of Attorney for Stock Transactions and Corporate Powers is used by a
                             shareholder in a corporation to authorize an agent to perform all acts necessary for stock
                             transactions and other corporate powers. This document allows the appointed agent to act
                             on behalf of the individual for the limited purpose of exercising stock options and voting
                             rights. Some of the acts authorized include receiving and conveying stock certificates,
                             entering into agreements and executing bank documents. This document can be
                             customized to fit the unique needs of the individual. It should be used by shareholders
                             located in New Hampshire to appoint an agent to act on their behalf for this limited purpose.
             ®




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        LIMITED POWER OF ATTORNEY FOR STOCK TRANSACTIONS AND
                          CORPORATE POWERS

STATE OF New Hampshire

COUNTY OF __________________________

KNOW ALL MEN BY THESE PRESENTS:

That I, ____________________________ [Instruction: Insert the name of person/principal
making this power of attorney] residing at ______________________________ [Instruction:
Insert the address of person/principal making this power of attorney] (hereinafter referred to
as the “Principal”) being of sound mind and memory, do hereby make, constitute and appoint
____________________________ [Instruction: Insert the name of Agent] residing at
_________________________________ [Instruction: Insert the address of Agent], as my true
and lawful Attorney-in-Fact (hereinafter referred to as the “Attorney-in-Fact”),

THIS DOCUMENT SHALL BE CONSTRUED AND INTERPRETED AS A LIMITED
POWER OF ATTORNEY AND THE ATTORNEY-IN-FACT SHALL HAVE THE POWER
AND AUTHORITY TO PERFORM OR UNDERTAKE ANY ACTION I COULD PERFORM
OR UNDERTAKE IF I WERE PERSONALLY PRESENT.

I hereby authorize the Attorney-in-Fact to act with the following limited powers:

Exercising stock options and voting all of my shares of stock in
______________________________________ [Instruction: Insert the name of Corporation
where the stock is deposited] a Corporation incorporated in the State of New Hampshire,
(hereinafter referred to as the "Corporation"), without the necessity of a proxy and the right to
appoint proxies therefore, and possessing all powers that I possess as granted to me by the
Bylaws of the Corporation, to incorporate, reorganize, merge, consolidate, recapitalize, sell,
liquidate or dissolve any business; elect or employ officers, directors and agents; carry out the
provisions of any agreement for the sale of any business interest or the stock therein. These
powers include, but are not limited to, the following:

1. To receive, hold, transfer, sell and convey any stock certificates of the Corporation and all
   documents of title in connection therewith;

2. To make, execute and deliver, in my name and on my behalf, for any consideration
   whatsoever, for cash, instruments of conveyance covering the stock of the Corporation,
   containing such terms, covenants and conditions deemed necessary or advisable by the
   Attorney-in-Fact;

3. To acquire, receive and retain investments without regards to principles of diversification,
   and without regard to predominance of common stock, or stock in closely held corporations;

4. To enter into any plan or agreements for sale, merger, consolidation, liquidation,
   recapitalization or other disposition of any trust or estate property, or of any corporation



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   issuing securities held as part of my estate or any trust; and to accept in such transactions any
   cash, securities or property that the Attorney-in-Fact deems proper;

5. To execute, in my name and on my behalf, such contracts or other assurances as may be
   requested or required by any bank or other institution or individual when carrying out the
   powers granted herein; and

6. To acquire, exchange, buy or sell my stock in the Corporation, or any interest therein, on
   such terms and conditions as the Attorney-in-Fact shall deem fit and proper. To execute and
   deliver, in my name and on my behalf, conveyances of said stock.

FURTHER, I do authorize the Attorney-in-Fact to execute, acknowledge and deliver any
instrument under seal or otherwise, and to do all things necessary to carry out the intent hereof,
hereby granting unto the Attorney-in-Fact full power and authority to act in and concerning the
premises as fully and effectually as I may do if personally present, limited, however, to the
purpose for which this limited power of attorney is executed.

PROVIDED, however, that all business transacted hereunder for me or for my account shall be
transacted in my name, and that all endorsements and instruments executed by the Attorney-in-
Fact for the purpose of carrying out the foregoing powers shall contain my name, followed by
that of the Attorney-in-Fact.

DURABILITY. [Instruction: Choose any one option as per applicable and mark it “X”]

This Power of Attorney shall be:

( _________ ) Non-Durable;

( _________ ) Durable and shall not be affected by any subsequent disability or incompetence.

I further declare that any act or thing lawfully done hereunder and within the powers herein
stated by the Attorney-in-Fact shall be binding on myself and my heirs, legal and personal
representatives and assigns, whether the same shall have been done either before or after my
death or other revocation of this instrument, unless and until reliable intelligence or notice
thereof shall have been received by the Attorney-in-Fact.

IN WITNESS WHEREOF, I have executed this Limited Power of Attorney and here unto set
my hand and seal this _______ [Month] _______ [Date], 20_____



___________________________________
[Instruction: Insert signature of Principal]

_____________________________________________
 [Instruction: Insert typed/printed name of Principal]




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___________________________________
[Instruction: Insert signature of Agent]

_____________________________________________
 [Instruction: Insert typed/printed name of Agent]




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                                         ATTESTATION



The hereinafter named Witnesses, each declare under penalty of perjury under the laws of the
State of New Hampshire, that the Principal is personally known to us, that the Principal signed
and acknowledged this Limited Power of Attorney in our presence, that the Principal appears to
be of sound mind and under no duress, fraud or undue influence, that we are not the person
appointed as the Attorney-in-Fact by this document and that we witnessed this Limited Power of
Attorney in the presence of the Principal. We are not related to the Principal by blood, marriage
or adoption, and to the best of our knowledge, are not entitled to any part of the estate of the
Principal upon the death of the Principal under a will now existing or by operation of law.



Witnesses # 1                                                  Witness # 2

__________________________                                     __________________________

Signature                                                      Signature



Name: ____________________                                     Name: ____________________

Address: ____________________                                  Address: ____________________




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                                     ACKNOWLEDGMENT



State of New Hampshire

County of __________________



I, the undersigned, a Notary Public in and for said County in said State, hereby certify that
_________________________, who is known to me, acknowledged before me on this day that,
being informed of the contents of the instrument, he/she executed the same voluntarily on the
day the same bears date.



Given under my hand and official seal this the ________ day of ________, ____.



                                                       __________________________________

                                                         Notary Public



My Commission Expires: ______________



(SEAL)




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Description: This Limited Power of Attorney for Stock Transactions and Corporate Powers is used by a shareholder in a corporation to authorize an agent to perform all acts necessary for stock transactions and other corporate powers. This document allows the appointed agent to act on behalf of the individual for the limited purpose of exercising stock options and voting rights. Some of the acts authorized include receiving and conveying stock certificates, entering into agreements and executing bank documents. This document can be customized to fit the unique needs of the individual. It should be used by shareholders located in New Hampshire to appoint an agent to act on their behalf for this limited purpose.
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