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SPECIAL POWER OF ATTORNEY



	I, ___________(1)___________, of __________(2)_________, hereby appoint 

______________(3)________________ of ___________(4)_______________, as my attorney in 

fact to act in my capacity to do any and all of the following:  



	(DESCRIBE THE EXTENT OF AUTHORITY YOU ARE GIVING TO YOUR ATTORNEY-

IN-FACT) 



	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 

____________(5)_______, 19__(6)_, and shall remain in full force and effect until 

___________(7)_______________ or unless specifically extended or rescinded earlier by either 

party.  



	Dated ___________(8)______________, 19__(9)_.  



	          ____________(10)______________ 





	STATE OF _______(11)____________  



	COUNTY OF ______(12)____________  



	BEFORE ME, the undersigned authority, on this _(13)_ day of _______(14)________, 

19_(15)_, personally appeared ___________(16)___________ 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.  



                               _________(17)___________________  

                                              NOTARY PUBLIC  



                                 My Commission Expires:__(18)____





NOTICE



	The information in this document is designed to provide an outline that you can follow 

when formulating business or personal plans.  Due to the variances of many local, city, county 

and state laws, we recommend that you seek professional legal counseling before entering into 

any contract or agreement.