Power Of Attorney (Page 3 of 5) in pdf

, §633B.301

SPECIAL INSTRUCTIONS (OPTIONAL)

You may give special instructions on the following lines:

___________________________________________________________

_________________________ shall have the authority to request an

accounting of any agent.

EFFECTIVE DATE

This power of attorney is effective immediately upon signature

and acknowledgment unless I have stated otherwise in the optional

Special Instructions.

NOMINATION OF CONSERVATOR AND 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 _____________

Nominee’s Address ________________________________________

Nominee’s Telephone Number _______________________________

Name of Nominee for Guardian of My Person ________________

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

_____________________________

_________________________

Your Signature

Date

_____________________________

Your Name Printed

_____________________________

Your Address

_____________________________

Your Telephone Number

State of ____________________

County of ___________________

This document was acknowledged before me on _______________

(date), by __________________________ (name of principal)

_____________________________

(Seal, if any)

Signature of Notary

My commission expires ________________

This document prepared by

___________________________________________________________

Thu May 19 10:21:01 2016

Iowa Code 2016, Section 633B.301 (6, 1)

Power Of Attorney Page 3

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