Montana Statutory Form Power Of Attorney Page 3
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4SPECIAL INSTRUCTIONS (OPTIONAL)
You may give special instructions on the following lines:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
This Power of Attorney is specific to the following real property.
EFFECTIVE DATE
This power of attorney is effective immediately unless I have stated otherwise in the Special Instructions.
NOMINATION OF CONSERVATOR OR GUARDIAN (OPTIONAL)
If it becomes necessary for a court to appoint a conservator or guardian of my estate or guardian of my
person, I nominate the following person(s) for appointment:
Name of Nominee for Conservator or
_______________________________________________
Guardian of my estate:
Nominee's Address:
_______________________________________________
Nominee's Phone Number:
_______________________________________________
Name of Nominee for Guardian of my person
________________________________________________
Nominee's Address:
________________________________________________
Nominee's Phone Number:
_______________________________________________
RELIANCE ON THIS POWER OF ATTORNEY
Any person, including my agent, may rely upon the validity of this power of attorney or a copy of it
unless that person knows it has terminated or is invalid.
SIGNATURE AND ACKNOWLEDGMENT
Your Signature:
______________________________________________________
Date:
______________________________________________________
Your Name Printed:
______________________________________________________
Your Address:
______________________________________________________
______________________________________________________
Your Phone Number:
______________________________________________________
________________
)
STATE OF
SS.
COUNTY OF
________________
)
This instrument was acknowledged before me on_________________, 20____,
by___________________________________________________________________________________.
__________________________________________
__________________________________________
Notary Public for the State of __________________
Residing at: ________________________________
My Commission Expires: ______________________
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