Special Power Of Attorney Form (Page 2 of 2) in pdf

FURTHER, I declare that this power shall remain in effect even though I am reported or

listed, officially or otherwise, as "missing," "missing in action" or "prisoner of war," it being my

intention that the designation of such status shall not bar my said attorney(s) from fully and

completely exercising and continuing to exercise any and all powers and rights herein granted

until this power is revoked by my death or as otherwise provided herein.

FURTHER, this power shall not be affected should I subsequently become disabled or

incapacitated.

FURTHER, unless sooner revoked or terminated by me, this Special Power of Attorney shall

become NULL AND VOID from and after the ______ day of ________________, ______.

Notwithstanding my insertion of a specific expiration date herein, if on the above specified

expiration date, or if at any time within thirty (30) days immediately preceding that date, I should

be, or have been, carried in a military status as "missing," "missing in action" or "prisoner of

war," then this power shall automatically continue to remain valid and in full effect until sixty

(60) days after I have returned to United States military control following termination of such

status.

IN WITNESS WHEREOF I have hereunto set my hand this ______ day of ___________, _____.

______________________________________

ACKNOWLEDGMENT

WITH THE ARMED FORCES OF THE

)

UNITED STATES ON OKINAWA, JAPAN )

I, _________________________, the undersigned commissioned officer, do hereby certify that

on this _______ day of ________________, _______, before me personally appeared

____________________________________, who is known to me to be the identical person who

is described in, whose name is subscribed to, and who signed and executed the foregoing

instrument. Further, after having made known to him/her the contents thereof, he/she personally

acknowledged to me that he/she signed and sealed the same as his/her true, free, and voluntary act

and deed for the uses, purposes, and considerations therein set forth.

AUTHORIZED AND DESIGNATED TO ACT AS A NOTARY UNDER

10 U.S.C, SECS 936 AND 1044A, AND MCO P5800.8 PARA. 1005.

______________________________________

SIGNATURE

PRINTED NAME

GRADE

SERVICE COMPONENT

TITLE

Special Power Of Attorney Form Page 2