Maryland Statutory Form - Limited Power Of Attorney Template Page 18
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20STATE OF MARYLAND
(COUNTY) OF _________________________________________________________________
This document was acknowledged before me on
_____________________________________________________________________________ ,
(Date)
by ___________________________________________________________________________ .
(Name of Principal)
________________________________
(Seal, if any)
Signature of Notary
My commission expires: ________________________________________________________
WITNESS ATTESTATION
The foregoing power of attorney was, on the date written above, published and declared
by
______________________________________________________________________________
(Name of Principal)
in our presence to be his/her power of attorney. We, in his/her presence and at his/her
request, and in the presence of each other, have attested to the same and have signed
our names as attesting witnesses.
____________________________________________
Witness #1 Signature
____________________________________________
Witness #1 Name Printed
____________________________________________
____________________________________________
Witness #1 Address
____________________________________________
Witness #1 Telephone Number
____________________________________________
Witness #2 Signature
____________________________________________
Witness #2 Name Printed
____________________________________________
____________________________________________
Witness #2 Address
____________________________________________
Witness #2 Telephone Number
This document prepared by:
________________________________________________________________________________
– 18 –
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