General Power Of Attorney Page 3
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DESIGNATION OF AGENT
I, _______________________, name the following person as my agent:
(Name of individual you choose as agent)
(address)(city)(state)(zip code)
(home phone)
(work phone)
DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)
If my agent is unable or unwilling to act for me, I name as my successor agent:
(Name of individual you choose as successor agent)
(address)(city)(state)(zip code)
(home phone)
(work phone)
If my successor agent is unable or unwilling to act for me, I name as my second successor
agent:
(Name of individual you choose as second successor agent)
(address)(city)(state)(zip code)
(home phone)
(work phone)
FORM
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Parent category: Legal