Special Power Of Attorney printable pdf download

Special Power Of Attorney

St. Mary’s County Department of Land Use and Growth Management

23150 Leonard Hall Drive, Leonardtown, Md. 20650

Phone (301) 475-4200, ext. 1500 Fax (301) 475-4672

SPECIAL POWER OF ATTORNEY

This

day of

, 20

, I

, (“Grantor”), the owner or contract

purchaser (circle one) of

(the “Property”), make, constitute, and appoint

(“Agent”), my true and lawful attorney-in-fact, and in my name, place and stead

giving unto said Agent full power and authority to do and perform all acts and make all

representations necessary, without any limitation whatsoever, to make application for the

Property to the St. Mary's County Department of Land Use and Growth Management: (specify

the approval sought for which Agent has your permission to act on your behalf and receive all

correspondence, i.e., Building Permit, Zoning Permit, Variance Approval, Conditional Use,

etc.)

The right, powers and authority of said Agent herein granted shall commence and be in full force

and effect on the date first written above and shall remain in full force and effect thereafter until

actual notice, by certified mail, return receipt requested, is received by the St. Mary's County

Department of Land Use and Growth Management stating that the terms of this power have been

revoked or modified.

_______________________________

Grantor

STATE OF MARYLAND

)

COUNTY OF ST. MARY’S )

Subscribed and sworn before me this the _____ day of ____________, 20__.

WITNESS my hand and official seal.

______________________________

Notary Public

My commission expires:

LUGM Form 36 (Rev 9/27/06)

Special Power Of Attorney