Limited Power of Attorney

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									Power of Attorney – Specific
This power of attorney can be used to grant specific powers to an agent. Rather than a
general power of attorney that grants broad powers, the principal must clearly specify
which powers they want the agent to have with this power of attorney. Simply enter your
information in the yellow highlighted fields, delete the bolded instructions, and you will
have a customized power of attorney that will protect your interests.
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:

    1.     _______________________________________________________________
    2.     _______________________________________________________________
    3.     _______________________________________________________________
    4.     _______________________________________________________________
    5.     _______________________________________________________________

[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or rescinded earlier by either party.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]

By: ______________________________________
        _______________________ [Instruction: insert name]

                                    NOTARIAL ACKNOWLEDGEMENT

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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