Illinois Statutory Short Form Power Of Attorney For Property Page 3
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79.
If a guardian of my estate (my property) is to be appointed, I nominate the agent acting under this power of
attorney as such guardian, to serve without bond or surety.
10.
I am fully informed as to all the contents of this form and understand the full import of this grant of powers to
m
y agent.
Signed ________
(Principal)
(YOU MAY, BUT ARE NOT REQUIRED TO, REQUEST YOUR AGENT AND SUCCESSOR AGENTS TO PROVIDE SPECIMEN
SIGNATURES BELOW. IF YOU INCLUDE SPECIMEN SIGNATURES IN THIS POWER OF ATTORNEY, YOU MUST COMPLETE
THE CERTIFICATION OPPOSITE THE SIGNATURES OF THE AGENTS.)
Specimen signatures of agent
I certify that the signatures of my agent (and
successors
(successors)
are correct)
(Agent)
(Principal)
(Successor Agent)
(Principal)
(Successor Agent)
(Principal)
(THIS POWER OF ATTORNEY WILL NOT BE EFFECTIVE UNLESS IT IS NOTARIZED, USING THE FORM
BELOW.)
State of
)
County of
) SS.
The undersigned, a notary public in and for the above County and State, certifies that
,
known to me to be the same person whose name is subscribed as principal to the foregoing power of attorney,
appeared before me in person and acknowledged signing and delivering the instrument as the free and voluntary act
of the principal, for the uses and purposes therein set forth, (and certified to the correctness of the signature(s) of the
agent(s)).
Dated
Notary Public
My commission expires:
The undersigned witness certifies that _______________________________, known to me to be the same
person whose name is subscribed as principal to the foregoing power of attorney, appeared before me and the notary
public and acknowledged signing and delivering the instrument as the free and voluntary act of the principal, for the
uses and purposes therein set forth. I believe him or her to be of sound mind and memory.
_______________________________Residing at _______________________________________________________
(witness)
(THE NAME AND ADDRESS OF THE PERSON PREPARING THIS FORM SHOULD BE INSERTED IF THE AGENT WILL HAVE
POWER TO CONVEY ANY INTEREST IN REAL ESTATE.)
THIS DOCUMENT PREPARED BY:
Brian N. Rubin
Special Needs Future Planning
BRIAN RUBIN & ASSOCIATES
1110 Lake Cook Road, Suite 165
Buffalo Grove, IL 60089-1997
(847) 279-7999; Fax (847) 279-0090
E-mail: brian@SNFP.net
Page 3 of 7 – Brian Rubin – Special Needs Future Planning – Law Offices of Brian Rubin & Associates – 866.to.rubin –
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