THE UNIVERSITY OF CHICAGO
STUDENT LOAN ADMINISTRATION
970 East 58th Street, Room 411, Chicago, IL 60637 www.uchicago.edu/student/loans; e-mail: student-loans@uchicago.edu phone: (773) 702-6061; fax: (773) 702-3238
Limited Power of Attorney Form
(With Durable Provision)
TO ALL PERSONS, be it known, that I, ___________________________as Grantor (borrower), do hereby make and grant a limited and specific power of attorney to _________________________ and appoint and constitute said individual as my attorney-in-fact. My named attorney-in-fact shall have full power and authority to undertake, commit and perform only the following acts on my behalf to the same extent as if I had done so personally; all with full power of substitution and revocation in the presence. Describe the specific authority below:
The authority granted shall include such incidental acts as are reasonably required or necessary to carry out and perform the specific authorities and duties stated or contemplated herein. My attorney-in-fact agrees to accept this appointment subject to its terms, and agrees to act and perform in said fiduciary capacity consistent with my best interests as he in his discretion deems advisable, and I thereupon ratify all acts so carried out.
Special durable provision: This power of attorney shall not be affected by disability of the Grantor, and shall become null and void after _________________________ (month/day), __________________ (year).
Grantor must sign in the presence of a licensed notary:
Signed under seal this_______________day of __________________ (month), 20________ (year)
Grantor ‘s Signature
Grantor’s Social Security #
Grantor’s UChicago ID #
Then personally appeared __________________, the above named Grantor, who known to me signed or acknowledged the foregoing power of attorney as his or her free act and deed, before me. Notary Public: Printed Name Signature Commission Expiration Date
PowerAtty.doc: 7/13/2007