Special Power of Attorney

9/6/2013

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specifically extended or rescinded earlier by either party.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)______________, 20__(9)_.

      ____________(10)______________


STATE OF _______(11)____________

COUNTY OF ______(12)____________

BEFORE ME, the undersigned authority, on this _(13)_ day of
_______(14)________, 20_(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.

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