Uniform Statutory Form Power Of Attorney - State Of California (Page 2 of 3) in pdf

SPECIAL INSTRUCTIONS:

ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS LIMITING OR EXTENDING THE

POWERS GRANTED TO YOUR AGENT:

UNLESS YOU DIRECT OTHERWISE ABOVE, THIS POWER OF ATTORNEY IS EFFECTIVE IMMEDIATELY AND

WILL CONTINUE UNTIL IT IS REVOKED.

This power of attorney will continue to be effective even though I become incapacitated.

STRIKE THE PRECEDING SENTENCE IF YOU DO NOT WANT THIS POWER OF ATTORNEY TO CONTINUE IF

YOU BECOME INCAPACITATED.

EXERCISE OF POWER OF ATTORNEY WHERE MORE THAN ONE AGENT DESIGNATED

If I have designated more than one agent, the agents are to act

IF YOU APPOINTED MORE THAN ONE AGENT AND YOU WANT EACH AGENT TO BE ABLE TO ACT ALONG

WITHOUT THE OTHER AGENT JOINING, WRITE THE WORD “SEPARATELY” IN THE BLANK SPACE ABOVE. IF

YOU DO NOT INSERT ANY WORD IN THE BLANK SPACE, OR IF YOU INSERT THE WORD “JOINTLY”, THEN ALL

OF YOUR AGENTS MUST ACT OR SIGN TOGETHER.

I agree that any third party who receives a copy of this document may act under its. Revocation of the power of

attorney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree to indemnify

the third party for any claims that arise against the third party because of reliance on this power of attorney.

Signed this __________ day of ___________________________________________, _____________

Your Signature

Your Social Security Number

State of California

County of _________________________________________

On __________________before me, (here insert name and title of the officer), personally appeared

__________________, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are

subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their

authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of

which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is

true and correct.

WITNESS my hand and official seal.

Signature ____________________________________________ (Seal)

Uniform Statutory Form Power Of Attorney - State Of California Page 2