Louisiana'S Military Power Of Attorney Page 3

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This power of attorney will:
________ Continue to be effective even though I become incapacitated.
________ Terminate when I become incapacitated.
EXERCISE OF POWER OF ATTORNEY WHERE MORE THAN ONE AGENT DESIGNATED
If I have designated more than one agent, the agents are to act:
____ separately or ____ jointly.
I agree that any third party who receives a copy of this document may act under it. I agree that
any transaction entered into by any third party in reliance on this document shall be binding
upon me and I hereby waive all rights I may have to challenge the authority of the named agent,
except to recover against him. Revocation of the power of attorney is not effective as to a third
party until the third party has actual knowledge of the revocation.
__________________________________________
Name:_____________________________________
SSN:(optional)______________________________
Done and passed at the Parish of ________________, Louisiana, on the day and date
first above written, in the presence of the undersigned competent witnesses, (two witnesses
preferred, but only required if line (P) is initialed) who sign with appearer and me, officer, after
due reading of the whole.
WITNESSES:
_______________________________________________
Name:__________________________________________
_______________________________________________
Name:__________________________________________
________________________________________
Notary Public:_____________________________
Notary Number:___________________________
My commission expires:____________________

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