Specific Power Of Attorney Form - Congressional Federal Credit Union
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1U.S. House of Representatives
Specific Power of Attorney
For Your Account(s) at Congressional Federal Credit Union
NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING. IF YOU HAVE ANY QUESTIONS ABOUT THESE POWERS, OBTAIN COM-
PETENT LEGAL ADVICE. THIS DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL AND OTHER HEALTH-CARE DECISIONS FOR YOU. YOU MAY
REVOKE THIS POWER OF ATTORNEY IF YOU LATER WISH TO DO SO BY SUBMITTING A NOTARIZED LETTER REQUESTING THE REVOCATION OF THIS POWER
OF ATTORNEY. THIS POWER OF ATTORNEY IS REVOKED UPON NOTICE TO US OF YOUR DEATH.
I, ____________________________________________________________ [insert your name], residing at __________________________________________________
________________________________________________________________ [your address] appoint ________________________________________________________
[insert the name of the person appointed] residing at ________________________________________________________________________________________________
[address of person appointed] as my attorney-in-fact (Agent) to act for me in any lawful way with respect to the following initialed subjects as to my account(s)
number(s) ________________________________________________________ and all sub-accounts relating to this/these account(s)*:
TO GRANT ALL OF THE FOLLOWING POWERS, INITIAL THE LINE IN FRONT OF (J) AND IGNORE THE LINES IN FRONT OF THE OTHER POWERS.
TO GRANT ONE OR MORE, BUT FEWER THAN ALL, OF THE FOLLOWING POWERS, INITIAL THE LINE IN FRONT OF EACH POWER YOU ARE GRANTING.
TO WITHHOLD A POWER, DO NOT INITIAL THE LINE IN FRONT OF IT. YOU MAY, BUT NEED NOT, CROSS OUT EACH POWER WITHHELD.
TRANSACTIONS TO INCLUDE:
PLEASE INITIAL. YOU NEED NOT INITIAL ANY OTHER LINES IF YOU INITIAL LINE (J).
____________ (A) Share and share draft deposits.**
____________ (F) Negotiate share drafts.**
____________ (B) Transfers between accounts listed above and between
____________ (G) Initiate wire transfers.**
the subshares of this/these account(s).**
____________ (H) Account inquiries, including VISA and Loan(s).**
____________ (C) Loan payments.**
____________ (I) Address Changes.**
____________ (D) Purchase certificates. **
____________ (J) ALL OF THE POWERS LISTED.**
____________ (E) Cash and check share withdrawals.**
* IF ANY ACCOUNT LISTED ABOVE IS AN INDIVIDUAL RETIREMENT ACCOUNT, YOU GRANT THE FOLLOWING POWERS ONLY:
(A) Make annual contributions** (B) Purchase certificates** (C) Make account inquiries** (D) Make Distributions**
**Attorney-in-fact is authorized to receive balance information, periodic statements and transaction receipts.
This Power of Attorney does not authorize the attorney-in-fact to establish accounts, close accounts, or negotiate loan agreements on my behalf.
ON THE FOLLOWING LINE YOU MAY GIVE SPECIAL INSTRUCTIONS LIMITING OR EXTENDING THE POWERS GRANTED TO YOUR ATTORNEY-IN-FACT.
SPECIAL INSTRUCTIONS ________________________________________________________________________________________________________________________
Attorney-in-fact
SSN: ____________________________________________________________ Date of Birth___________ Mother’s Maiden Name__________________________________
This is a specimen of the signature of the attorney-in-fact appointed hereby: ______________________________________________________________________________
Signature of Attorney-in-fact
UNLESS YOU DIRECT OTHERWISE ABOVE, THIS POWER OF ATTORNEY IS EFFECTIVE IMMEDIATELY AND WILL CONTINUE UNTIL IT IS REVOKED BY ME IN THE
MANNER SPECIFIED ABOVE OR UPON NOTICE TO THE CREDIT UNION OF MY DEATH.
This power of attorney will continue to be effective even though I become disabled, incapacitated, or incompetent.
STRIKE THE PRECEDING SENTENCE IF YOU DO NOT WANT THIS POWER OF ATTORNEY TO CONTINUE UPON NOTICE TO THE CREDIT UNION THAT YOU
HAVE BECOME DISABLED, INCAPACITATED, OR INCOMPETENT.
I agree that Congressional Federal Credit Union, its officers, directors, employees, agents, and assigns (the Credit Union) upon receiving a copy of this document may
act under it. I agree to indemnify the Credit Union for any claims that arise against the Credit Union because of use of this power of attorney.
Signed this _____________ day of ______________________, _______
________________________________________________________________________________
Your Signature (Notary Required)
STATE OF _____________________________________________ COUNTY OF _______________________________________
On this _________________ day of _______________________________, _______________, before me, a notary public in
and for said state, personally appeared _________________________________________________________________, to me
personally known, who being duly sworn, acknowledged that he/she had executed the foregoing instrument for purposes
therein mentioned and set forth.
Notary Public ____________________________________________________ My Commission Expires __________________
BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE ATTORNEY-IN-FACT ASSUMES THE FIDUCIARY AND
OTHER LEGAL RESPONSIBILITIES OF AN ATTORNEY-IN-FACT.
notary seal
POA 0904
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