Limited Power Of Attorney Form - Mississippi (Page 2 of 2) in pdf

Limited Power Of Attorney Form - Mississippi Page 2

LIMITED POWER OF ATTORNEY TO SECURE

YOUR FREEDOM!

I, ____________________(your/teen’s name here), of ________ ____________, (your

address)

hereby

appoint

______________________

(trusted

person),

______________________ (trusted person’s address), as my attorney in fact to act in my

capacity to do every act that I may legally do through an attorney in fact to obtain my

release from any institution where I may be involuntarily placed prior to reaching age of

majority. This power shall be in full force and effect on the date below written and shall

remain in full force and effect until _________________ (date of your/teen’s nineteenth

birthday) or unless specifically extended or rescinded earlier by either party.

Dated ___________________,(Month and Day)_________(Year).

Signed___________________________ (your/teen’s name here)

STATE OF _________Mississippi___________

COUNTY OF __________________

BEFORE ME, the undersigned witness, on this ___________ (Day of Month) day of

______________ (Month), ________(Year), personally appeared to me well known to be

the person described in and who signed the Foregoing, and acknowledged to me that

he/she executed the same freely and voluntarily for the uses and purposes therein

expressed.

WITNESS my hand the date aforesaid.

_________________________(signature of witness)

__________________________________(address of witness)

*Witness needs to be third party, not the authorizing teenager nor the authorized/trusted

person named above. Notary would be best!

Limited Power Of Attorney Form - Mississippi Page 2