This Limited Power of Attorney is used by an individual to grant specific powers to an
agent. This document specifies particular acts that an attorney-in-fact may perform on
behalf of the individual. Unlike a general power of attorney, which allows the attorney-
in-fact to perform all acts the individual could do personally, this document limits the
attorney-in-fact's authority to perform certain functions. Some common powers granted
are collection of debts, borrowing money, and acquisition of property. This form is
highly customizable and should be used by individuals wishing to grant only certain
powers to an agent.
LIMITED POWER OF ATTORNEY
I, ___________________ [Instruction: insert name] of ____________________ [Instruction:
insert address], hereby appoint ___________________ [Instruction: insert name] of
____________________ [Instruction: insert address], as my attorney in fact to act in my
capacity to do any and all of the following:
[Instruction: describe specific activities for which you are granting this power of attorney]
The rights, powers, and authority of my attorney-in-fact to exercise any and all of the rights and
powers herein granted shall commence and be in full force and effect on the ___ day of
__________, 20____, [Instruction: insert date] and shall remain in full force and effect until
the ___ day of __________, 20____, [Instruction: insert date] or unless specifically extended
or rescinded earlier by either party.
Dated: __________, 20____ [Instruction: insert date]
_______________________ [Instruction: insert name]
STATE OF _____________ COUNTY OF_______________
BEFORE ME, the undersigned authority, on this _________________ day of ______________,
20____, 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.
WITNESS my hand and official seal the date aforesaid.
_____________________ NOTARY PUBLIC
My Commission Expires: __________________
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