Form E34l Sample - Power Of Attorney (Limited Purpose)

POWER OF ATTORNEY

(LIMITED PURPOSE)

IMPORTANT INFORMATION

This power of attorney authorizes another person (your agent) to make decisions for you

(the principal) and to act on your behalf concerning the limited purpose described below in the

Grant of Authority. You should select someone you trust to serve as your agent.

Unless you specify otherwise, generally the agent’s authority will continue until you die or

revoke the power of attorney or the agent resigns or is unable to act for you.

Your agent is entitled to reasonable compensation unless you state otherwise in the special

instructions.

This power of attorney does not authorize the agent to make health care decisions for you.

If you have questions about this power of attorney or the authority you are granting to

your agent, you should seek legal advice before signing this form.

DESIGNATION OF AGENT

I, ___________________________________________________________________________ (name of Principal),

name the following person as my agent:

Name of agent: ______________________________________________________________________________

Agent’s address: _____________________________________________________________________________

Agent’s telephone number: ______________________________________________________________________

GRANT OF AUTHORITY

I grant my agent the authority to act as my true and lawful agent and in my name, place, and stead for my sole

use and benefit, with full power and authority to do and perform each and every act necessary, as fully as I might

do if personally present to accomplish and complete the following act or transaction: (Describe in detail the act or

transaction, including the specific responsibilities and limitations allowed to perform the act or transaction.)

_________________________________________________________________________________________________________

LIMITATION ON AGENT’S AUTHORITY

An agent that is not my ancestor, spouse, or descendant MAY NOT use this power of attorney to benefit the

agent or a person to whom the agent owes an obligation of support. The authority granted in this power of attorney

is limited to the act or transaction described in this document.

No. e34L. Rev. 11-09.

POWER OF ATTORNEY (LIMITED PURPOSE) (Page 1 of 3)

Bradford Publishing, 1743 Wazee St., Denver, CO 80202 — (303) 292-2590 — — eForm

Form E34l Sample - Power Of Attorney (Limited Purpose) - 2009