Indiana Limited Financial Power Of Attorney Form Page 2

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V. PRINCIPAL - I, ______________________, residing at
Name of Principal
____________________________________________________________________
Street Address of Principal
City of ______________________, State of ______________________, appoint
City of Principal
State of Principal
the following as my Attorney-in-Fact, whom I trust with a specific financial act
or acts immediately upon the authorization of this form, and I grant the power
to act as if I were personally present to
VI. ATTORNEY-IN-FACT - ______________________, residing at
Name of Attorney-in-Fact
__________________________________________________________________
Street Address of Attorney-in-Fact
City of ______________________, State of ______________________ grant
City of Attorney-in-Fact
State of Attorney-in-Fact
the Attorney-in-Fact the legal authority for a specific financial act on my
behalf that can be any power legal under law in the State of
_________________________. The Specific financial act I grant my Attorney-in-
State
Fact is:
____________________________________________________________________
A Detailed Description of Exact Powers granted
VII. SUCCESSOR ATTORNEY-IN-FACT (Optional) – If the Attorney-in-Fact named
above cannot or is unwilling to serve, then I appoint ______________________,
Name of Successor Attorney-in-Fact
residing at:
____________________________________________________________________
Street Address of Successor Attorney-in-Fact
City of ______________________, State of ______________________ grant
City of Successor Attorney-in-Fact
State of Successor Attorney-in-Fact
the Attorney-in-Fact the legal authority for a specific financial act on my
behalf that can be any power legal under law in the State of
_________________________. The Specific financial act I grant my Successor
State
Attorney-in-Fact is:
____________________________________________________________________
A Detailed Description of Exact Powers granted

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