Form 1 - Special Power Of Attorney Appointment Of Agent

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COMMONWEALTH OF VIRGINIA
Department of Criminal Justice Services
P.O. Box 1300 • Richmond, VA 23218 • Phone: (804) 786-4700 • Fax: (804) 786-6344
SPECIAL POWER OF ATTORNEY
APPOINTMENT OF AGENT
KNOW ALL PERSONS BY THESE PRESENTS, that I ____________________________________________, presently
residing at ________________________________________________________________________________________,
have made, constituted, and appointed, and by these presents do hereby make, constitute, and appoint
_____________________________________ of the City/County of ______________________________, Virginia, my
true and lawful attorney-in-fact (“Attorney-in-Fact”) and lawful “agent” as defined in
§ 9.1-185
of the Virginia Code
(1950), as amended, who is hereby authorized for me and in my name to do the following:
To (a) execute and deliver bail bonds on my behalf for individuals before for the state courts of the
Commonwealth of Virginia, and (b) perform any other act or thing on my behalf that may be performed by an
agent bail bondsman pursuant to Virginia Code (1950), as amended, in those cities and/or counties in which
this Special Power of Attorney is registered. No individual bond may be executed by such Attorney-in-Fact.
The aggregate amount of bail bonds that my Attorney-in-Fact may execute may not exceed
$_________________.00 (If no limit, state “NO LIMIT”).
FURTHER, THIS POWER OF ATTORNEY shall remain in full force and effect until revoked, suspended, or terminated
by a document executed and acknowledged by me. This Power of Attorney shall be binding on me, my heirs, successors,
assigns, executors, administrators, and personal representatives, and any person receiving this Power of Attorney shall be
entitled to rely on the authority herein given until and unless a document expressly revoking the powers herein given is
received. Notwithstanding anything herein to the contrary, this Power of Attorney shall not terminate or be affected or
impaired by my disability, it being my express intention that this Power of Attorney shall survive my disability.
WITNESS my signature and seal this ______ day of ________________________, 20___.
___________________________________________________(SEAL)
Print Name: _________________________________________________
DCJS ID# ____________________________
STATE OF VIRGINIA
CITY/COUNTY OF _______________________, to wit:
The foregoing Special Power of Attorney was acknowledged before me this ______ day of ________________________,
20___ by _________________________________________.
My commission expires:
Notary Public
DCJS Special Power of Attorney – Appointment of Agent, PBB Form #1
Updated: 05/2014
Page 1 of 1

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