Form F-00036 - Designation Of Agent Page 5
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15RELIANCE ON THIS POWER OF ATTORNEY FOR FINANCES AND PROPERTY
Any person, including my agent, may rely upon the validity of this power of attorney or a copy of it unless that
person knows that the power of attorney has been terminated or is invalid.
SIGNATURE AND ACKNOWLEDGMENT
Your signature
____________
______ Date
Your name printed
Your address:
Your telephone number:
State of:
County of:
This document was acknowledged before me on
Date
by name of principal
(Seal, if any)
Signature of notary
Name of notary (typed or printed)
My commission expires:
This document prepared by:
Wisconsin Power of Attorney for Finances and Property
Page 4
F-00036 (Rev. 08/2016)
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