Indiana Limited Financial Power Of Attorney Form Page 6
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6Notary Acknowledgement (Must be completed by Notary)
State of ___________ County of ______________________________ Subscribed,
Sworn and acknowledged before me by ______________________________, the
Principal, and subscribed and sworn to before me by ______________________,
witness, this ______________________ day of ________________________.
______________________________
Notary Signature
Notary Public
In and for the County of ______________________________
State of ______________________________
My commission expires: ______________________________ Seal
Acknowledgement and Acceptance of Appointment as Attorney-in-Fact
I, ______________________________ have read the attached power of attorney
Name of Attorney-in-Fact
and am the person identified as the attorney-in-fact for the principal. I hereby
acknowledge that accept my appointment as Attorney-in-Fact and that when I
act as agent I shall exercise the powers for the benefit of the principal; I shall
keep the assets of the principal separate from my assets; I shall exercise
reasonable caution and prudence; and I shall keep a full and accurate of all
actions, receipts and disbursements on behalf of the principal.
______________________________ ______________________________
Signature of Attorney-in-Fact
Date
Acceptance of Appointment as successor Attorney-in-Fact
I, ______________________________ have read the attached power of
Name of successor Attorney-in-Fact
attorney and am the person identified as the successor attorney-in-fact for the
principal. I hereby acknowledge that I accept my appointment as Successor
Attorney-in-Fact and that, in the absence of a specific provision to the contrary
in the power of attorney, when I act as agent I shall exercise the powers for
the benefit of the principal; I shall keep the assets of the principal separate
from my assets; I shall exercise reasonable caution and prudence; and I shall
keep a full and accurate record of all actions, receipts, and disbursements on
behalf of the principal.
______________________________ ______________________________
Signature of Successor Attorney-in-Fact
Date
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