Limited Power of Attorney (MS Word) Limited Power of Attorney (Adobe PDF)
MS Word Adobe PDF

POWER OF ATTORNEY – LIMITED

(Note: Rules regarding legal sufficiency of a power of attorney vary by state. Please consult your state rules and have the form reviewed by a lawyer in your state regarding additional language, witness signatures, and notary requirements.)

1. I, [INSERT NAME and ADDRESS] the undersigned hereby make, constitute and appoint [INSERT NAME and ADDRESS] as my attorney-in-fact who shall have full power and authority to undertake and perform only the following acts on my behalf:

[INSERT SPECIFIC MATTERS FOR WHICH POWER OF ATTORNEY IS BEING USED]

(i) _______________________________________________________________
(ii) ______________________________________________________________
(iii) ______________________________________________________________

 

2. This Power of Attorney is effective immediately and will continue until I revoke it.

[OR]

2. This Power of Attorney shall be effective on the date of [INSERT DATE]. This Power of Attorney shall terminate on the date of [INSERT DATE], unless I revoke it sooner. I may at any time or by any manner revoke this Power of Attorney.

3. This Power of Attorney [WILL OR WILL NOT] continue to be effective even though I become incapacitated.

4. This Power of Attorney shall be governed by the State of [INSERT STATE].

 

Signed this __________ day of ______________________, __________.

________________________________________
(Your signature)

________________________________________
(Your Social Security number)

State of ________________________, County of _________________________, USA