Sample Printable Power of Attorney Form

I, ___________________________ residing at

___________________________________________ hereby appoint

_________________________ of _________________________________________________________,

________________________________, ____________________________, as my Attorney-in-Fact (“Agent”).

If my Agent is unable to serve for any reason, I designate

_______________________, of ___________________________________, ___________________ as my successor Agent.

I hereby revoke any and all general powers of attorney that previously have been signed by me.

Full Name _________________________ Signature ____________________ Date __________________

Acknowledgement:

STATE OF ______________________

The foregoing instrument was acknowledged before me this _________ day of _______________, 20 ____ by _________________ personally known to me or who has produced ______________ as identification.

Signature of person taking acknowledgment. _____________________