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Limited Power Of Attorney Form

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LIMITED POWER OF ATTORNEY

$_________ = Approximate Dollar Value of the Property

_________ = Number of Shares of Stock to be Recovered (If Applicable)

_________ = Percent to be Paid as Compensation to the Claimant's Representative

$_________ = Amount to be Paid to Claimant's Representative

$_________ = Net Amount to be Paid to Claimant

Property Account Numbers: ____________________________________________

Unclaimed Money 101, Inc. is engaged in research work locating the owners and/or heirs

of unclaimed property and the claimant agrees that Unclaimed Money 101, Inc. has

located him, her, and/or the organization through the investigative efforts of the

claimant’s representative. Claimant does hereby agree that in consideration of the efforts

made by the claimant’s representative that the claimant’s representative is hereby-

assigned ______% of any and all assets that the claimant is given from the above listed

unclaimed property account(s). The claimant’s representative and the claimant agree that

in the event Claimant is not entitled to assets described above and such assets are not

recovered, there is no further obligation on either party to the other.

X_______________________

__________

_________________________, Claimant

Date

________________________________________________________________

Address of Claimant

______________________

____________________________________________

Phone number of Claimant

Taxpayer Identification Number of Claimant

_______________________________________________________________________

Name and Address to whom the warrant is to be issued (if different from Claimant)

Robert E. Nygaard, Claimant’s Representative

License Number A2700197

Unclaimed Money 101, Inc.

4201 N. Ocean Blvd. Suite C1807

Boca Raton, FL 33431

Phone: (561)-596-3443 / Toll Free 1-877-262-6497

Limited Power Of Attorney Form

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