Fillable Form Spoa Special - Special Power Of Attorney (Page 3 of 4) in pdf

SPECIAL POWER OF ATTORNEY

I hereby give and grant unto my attorney-in-fact full power and authority to do and perform each and every act

and matter concerning the subject of this document as fully and effectually to all intents and purposes as I could do

legally if I were present.

I hereby authorize my attorney-in-fact to indemnify and hold harmless any third party who accepts and acts

under or in accordance with this power of attorney.

I hereby ratify all that my attorney-in-fact shall lawfully do or cause to be done by this document.

I intend for this to be a DURABLE Power of Attorney. This Power of Attorney will continue to be effective if I

become disabled, incapacitated, or incompetent. All acts done by my attorney-in-fact hereunder shall have the same

effect and inure to the benefit of and bind myself and my heirs as if I were competent, and not disabled, incapacitated, or

incompetent.

I shall be considered disabled or incapacitated for purposes of this Power of Attorney if a physician, based on

that physician's examination, certifies in writing at a date subsequent to the date which this Power of Attorney is

executed, that I am disabled from or incapable of exercising control over my person, property, personal affairs, or

financial affairs. I authorize the physician who so certifies, to disclose my physical or mental condition to another person

for purposes of this Power of Attorney. A third party who accepts this Power of Attorney, endorsed by proper physician

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

Attorney.

This power of attorney shall remain in full force and effect until the _______ day of

_________________________, 20____, unless sooner revoked by me.

Notwithstanding my inclusion of a specific expiration date herein, 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 in a military status of "missing," "missing in action," or "prisoner of war," or if 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 returned to United States military control following termination of such status or sixty (60)

days after I have recovered from such disability unless sooner revoked or terminated by me.

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 have hereunto set my hand and seal on this _________ day of

_____________________________, 20____.

_____________________________________________________

Signature

_____________________________________________________

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Page 3 of 4

SPOA SPECIAL 3-18-11

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Form Spoa Special - Special Power Of Attorney Page 3