Statutory Short Form Power Of Attorney

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STATUTORY SHORT FORM POWER OF ATTORNEY
MINNESOTA STATUTES SECTION 523.23
IMPORTANT NOTICE: The powers granted by this document are broad and sweeping. They are
defined in Minnesota Statutes § 523.24. If you have any questions about these powers, obtain
competent advice. This power of attorney may be revoked by you if you wish to do so. This Power of
Attorney is automatically terminated if it is to your spouse and proceedings are commenced for
dissolution, legal separation or annulment of your marriage. This power of attorney authorizes, but does
not require, the attorney-in-fact to act for you.
PRICIPAL (Name and Address of Person Granting the Power)
______________________________________
______________________________________
______________________________________
ATTORNEYS-IN-FACT
SUCCESSOR ATTORNEY (S)-IN-FACT
(Name and Address)(Optional) To act if any
Senior Options, Inc.
named attorney-in-fact dies, resigns, or is
PO Box 49097.
otherwise unable to serve. (Name and
Blaine, MN 55449
address)
763-792-4472
First Successor:
____________________________________
____________________________________
____________________________________
Second Successor:
____________________________________
____________________________________
____________________________________
NOTICE: If more than one attorney-in-fact
Is designated, make a check or “x” on the
Line in front of one of the following
statements:
______ Each attorney-in-fact may
EXPIRATION DATE (Optional)
independently exercise the
__________ _____, 20____
powers granted.
(Use Specific Month, Day, Year Only)
______ All attorneys-in-fact must
jointly exercise the powers
granted.

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