This sample Power of Attorney document provides that the signor of the document is
designating another person as the signor’s attorney in fact. This agreement allows the
specifically designated person to act on behalf of the grantor (the person who signs the
document). This document contains a notarial acknowledgement and must be signed
by a notary public. This short-form template is a basic grant of full power of attorney but
can be modified to fit the drafter’s specific needs.
FULL POWER OF ATTORNEY
I, __________________[NAME] of _________________[ADDRESS], hereby appoint
_________________ [NAME] of __________________[ADDRESS] as my attorney in fact to
act in my capacity to do every act that I may legally do through an attorney in fact. This power
shall be in full force and effect on the date below written and shall remain in full force and effect,
from _____________, 20___ [STARTING DATE] until __________, 20____ [ENDING
DATE], or unless specifically extended or rescinded earlier by either party.
Dated __________, 201____.
STATE OF __________COUNTY OF __________
BEFORE ME, the undersigned authority, on this __________ day of __________,
201__, personally appeared __________ to me well known to be the person described in and
who signed the foregoing, and acknowledged to me that he executed the same freely and
voluntarily for the uses and purposes therein expressed.
Powers conferred on said attorney-in-fact shall not be restricted or limited by the aforementioned
specifications regarding situation of representation. The rights, powers and authority of said
attorney-in-fact granted in this instrument shall commence and be in full force and effect on
____________, (Month & Day) _____, (Year) and such rights, powers and authority shall remain
in full force and effect thereafter until I give notice in writing that such power is terminated.
It is my desire, and I so freely state, that this power of attorney shall not be affected by any
subsequent disability or incapacity that may befall me.
FURTHERMORE, upon a finding of incompetence by a court of appropriate jurisdiction, this
power of attorney shall be irrevocable until such time as said court determines that I am no longer
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WITNESS my hand and official seal the date aforesaid.
My Commission Expires:
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after reading and following them. You (or your attorney) may want to make additional modifications to meet your specific needs and the
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