Power Of Attorney printable pdf download

Power Of Attorney

CITY OF CLERMONT

DEVELOPMENT SERVICES DEPARTMENT

POWER OF ATTORNEY

________________

Date

I hereby name and appoint ________________________________________________

To be my lawful attorney in fact to sign my documents pertaining to permits for the City

of Clermont - Building Services. (Check and complete the following)

 To sign for any and all documents until further notice.

 To this specific job for work to be performed at:

Location:______________________________________________________________

Alternate Key #_________________

Parcel ID #: Section_____________ Township_____________ Range_____________

Lot____________ Block____________ Subdivision___________________________

_______________________

Company name

________________________________

License #

________________________________

Name of Certified Contractor (Type or Print)

________________________________

Signature of Certified Contractor

State of Florida

County of Lake

The foregoing instrument was acknowledged before me this ____ day of _____________,

20___, by _____________________________________________ who, are personally

known to me or who has provided _______________________ as identification, and who

did take an oath.

_______________________________

Signature - Notary Public

_______________________________

Printed Name - Notary Public

My Commission Expires:

9-12-14

Power Of Attorney