Statutory Form Power Of Attorney (Utah) (Page 4 of 4) in pdf

Statutory Form Power Of Attorney (Utah) Page 4

EFFECTIVE DATE

This power of attorney is effective immediately unless I have stated otherwise in the

Special Instructions.

NOMINATION OF CONSERVATOR OR GUARDIAN (OPTIONAL)

If it becomes necessary for a court to appoint a conservator of my estate or guardian of

my person, I nominate the following person(s) for appointment:

Name of Nominee for conservator of my estate: None appointed in this instrument

Nominee's Address: ___________________________________________________________

Nominee's Telephone Number: __________________________________________________

Name of Nominee for guardian of my person: None appointed in this instrument

Nominee's Address: ___________________________________________________________

Nominee's Telephone Number: __________________________________________________

RELIANCE ON THIS POWER OF ATTORNEY

Any person, including my agent, may rely upon the validity of this power of attorney or a

copy of it unless that person knows it has terminated or is invalid.

SIGNATURE AND ACKNOWLEDGMENT

____________________________________________

_______________

Name

Date

address

phone number

STATE OF UTAH

: ss

COUNTY OF ________________

This document was acknowledged before me on the _____ day of _____________, 2016

by _________________________.

Notary Public

My commission expires:

Utah Statutory Power of Attorney Form for ___________________________

Page 4 of 4 Initials:_______

Statutory Form Power Of Attorney (Utah) Page 4