Pennsylvania General Durable Power Of Attorney (Page 5 of 7) in pdf

office of Agent, I name the following (each to act alone and successively, in the order named) as

successor(s) to such Agent:

________________________________________________________________________

Choice of Law. THIS POWER OF ATTORNEY WILL BE GOVERNED BY THE LAWS OF THE

COMMONWEALTH OF PENNSYLVANIA WITHOUT REGARD FOR CONFLICTS OF LAWS PRINCIPLES.

IT WAS EXECUTED IN THE COMMONWEALTH OF PENNSYLVANIA AND IS INTENDED TO BE VALID

IN ALL JURISDICTIONS OF THE UNITED STATES OF AMERICA AND ALL FOREIGN NATIONS.

I am fully informed as to all the contents of this form and understand the full import of this grant of powers to

my Agent.

I agree that any third party who receives a copy of this document may act under it. Revocation of the power

of attorney is not effective as to a third party until the third party learns of the revocation. I agree to indemnify

the third party for any claims that arise against the third party because of reliance on this power of attorney.

Signed this _______ day of _______________, 20____

______________________________

[Your Signature]

STATEMENT OF WITNESS

On the date written above, the principal declared to me in my presence that this instrument is his general

durable power of attorney and that he or she had willingly signed or directed another to sign for him or her,

and that he or she executed it as his or her free and voluntary act for the purposes therein expressed.

_______________________________________ [Signature of Witness #1]

_______________________________________ [Printed or typed name of Witness #1]

_______________________________________ [Address of Witness #1, Line 1]

_______________________________________ [Address of Witness #1, Line 2]

_______________________________________ [Signature of Witness #2]

_______________________________________ [Printed or typed name of Witness #2]

_______________________________________ [Address of Witness #2, Line 1]

_______________________________________ [Address of Witness #2, Line 2]

A Note About Selecting Witnesses: The agent (attorney-in-fact) may not also serve as a

witness. Each witness must be present at the time that principal signs the Power of Attorney in

front of the notary. Each witness must be a mentally competent adult. Witnesses should ideally

reside close by, so that they will be easily accessible in the event they are one day needed to

affirm this document's validity.

CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC

COMMONWEALTH OF PENNSYLVANIA

Pennsylvania General Durable Power Of Attorney Page 5