Special Power Of Attorney Template (Page 2 of 2) in pdf

physician certification of my disability or incapacity, is held harmless and fully protected from any action taken

under this power of attorney.

Notwithstanding my inclusion of a specific expiration date herein, if on that specified expiration date I should be or

have been properly certified, in writing, by a physician to be disabled from or incapable of exercising control over

my person, property, personal affairs, or financial affairs, then this Power of Attorney shall remain valid and in full

effect until sixty (60) days after I have recovered from such disability UNLESS OTHERWISE REVOKED OR

TERMINATED BY ME. Furthermore, if on the above-specified expiration date, or during the sixty (60) day

period preceding that specified expiration date, I should be or have been determined by the United States

Government to be a military status of “missing,” “missing in action,” or “ prisoner of war,” then this Power of

Attorney shall remain valid and in full effect until sixty (60) days after I have returned to the United States military

control following termination of such status UNLESS OTHERWISE REVOKED OR TERMINATED BY ME.

I HEREBY RATIFY ALL THAT MY ATTORNEY SHALL LAWFULLY DO OR CAUSE TO BE DONE

BY THIS DOCUMENT.

All business transacted hereunder for me or for my account shall be transacted in my name, and all endorsements

and instruments executed by my attorney for the purpose of carrying out the foregoing powers shall contain my

name, followed by that of my attorney and the designation “attorney-in-fact.”

IN WITNESS WHEREOF, I sign, seal, declare, publish, make and constitute this as and for my Power of Attorney

in the presence of the Notary Public witnessing it at my request this date, ________________________________.

______________________________

NAME

STATE OF MARYLAND

COUNTY OF MONTGOMERY

Subscribed, sworn to and acknowledged before me by __________________ on ________________________.

(SIGN)

________________________________________

(PRINT)

________________________________________

NOTARY PUBLIC

My Commission Expires:

_______________________________________.

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Special Power Of Attorney Template Page 2