Limited Power Of Attorney Instructions Sheet (Page 2 of 2) in pdf

Limited Power Of Attorney Instructions Sheet Page 2

LIMITED POWER OF ATTORNEY

To Whom It May Concern:

Please be advised that I, __________________________________________________,

of_____________________________________________________________________

Address:_________________________________ City ________________ State ____,

Zip Code _____________ Telephone # ________________________do hereby appoint

_______________________________________________as my attorney in fact for the

explicit purpose of executing documents in my stead, specifically builders/contractors

registration with Governmental units, and executing permit applications with said

Governmental units.

This limited power of attorney, hereinafter LPA, would be authorized for other associated

documents that may be required to be executed by myself by said Governmental units in

connection with the registration or permit applications.

________________________________________ will sign my name and also sign their

name as attorney-in-fact and attach a true copy of this document and it will have the same

effect and standing as if I had executed the document in person. If multiple persons are

listed only one person is required to execute the LPA

This LPA will expire on _________________.

If this LPA is revoked or modified prior to expiry date, grantor agrees to immediately

notify, in writing, all entities given this LPA of said revocation or modification, without

said notice the LPA will continue until expiry date.

End of LPA.

Signed: ______________________________________________ Dated: _____________

Statement of Notary

____________ County, Michigan

On this _____ day of __________________, 20____,

___________________________________________________, known to me, personally

appeared before me and signed and executed this document of his/her own free will.

My commission expires:______________

Notary signature: ____________________________________

______________County, Michigan

Printed name: _______________________________________

If a Corporation, this must be completed by license holder/qualifying officer.

Limited Power Of Attorney Instructions Sheet Page 2