(Sample Two) Limited Power Of Attorney Form

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(SAMPLE TWO)
LIMITED POWER OF ATTORNEY
I, _(insert full name of donor)
of _(insert full address and postal code) appoint
_(insert full name of lawyer appointed) of (insert full address and postal code) to be the attorney
for me and in my name and place to do all things required to be done on my behalf in order to
complete the [purchase / mortgage / sale] of (insert civic address or short legal description of the
property as referred to in the Offer or the Mortgage Commitment) contemplated by my
agreement with (insert full names of all other parties, including the donor’s mortgagee, if
applicable) dated _______. For that purpose (but without limitation), my attorney may execute
and deliver, or amend, correct, replace or re-execute and deliver, all documents, forms,
instruments, elections, acknowledgements, consents or releases (including any consent or release
under The Homesteads Act [Manitoba]), may give evidence on my behalf by way of affidavit,
statutory declaration or otherwise concerning any matter, and may do all lawful acts which, in
the opinion of my attorney, may be necessary or desirable.
SIGNED AND SEALED at ___________, Manitoba, this___ day of ___________20___.
Signed, published and declared by _______ )
in my presence, and at his/her request
)
and in his/her presence, I have hereunder
)
subscribed my name as a witness.
)
______________________________
)
_________________________________
Witness
)
Name and
Occupation
THE HOMESTEADS ACT
ACKNOWLEDGEMENT FOR POWER OF ATTORNEY
I, _______________________, the donor named in the above Limited Power of Attorney appointing
_________________________ as my attorney, acknowledge that:
1.
I am executing this Limited Power of Attorney freely and voluntarily, without any compulsion on
the part of my spouse or common-law partner;
2.
I am aware of the nature and effect of this Limited Power of Attorney; and
3.
I am executing this acknowledgement apart from my spouse or common-law partner.
_______________________
______________________
_______________________
(Name of Donor)
(Signature of Donor)
(Date)
______________________
______________________
________________________
(Name of Witness)
(Signature of Witness)
(Date)
A Commissioner for Oaths/Notary Public in and for
the Province of Manitoba. My Commission expires:
02/04

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