Nevada Statutory Power Of Attorney Form (Page 5 of 6) in pdf

Nevada Statutory Power Of Attorney Form Page 5

Power of Attorney

Page 5

SPECIAL INSTRUCTIONS OR OTHER OR ADDITIONAL AUTHORITY GRANTED TO

AGENT:

DURABILITY AND EFFECTIVE DATE. (INITIAL each clause that applies.)

[_____] DURABLE. This Power of Attorney shall not be affected by my subsequent disability or incapacity.

[_____] SPRINGING POWER. It is my intention and direction that my designated agent, and any person

or entity that my designated agent may transact business with on my behalf, may rely on a written medical

opinion issued by a licensed medical doctor stating that I am disabled or incapacitated, and incapable of

managing my affairs, and that said medical opinion shall establish whether or not I am under a disability for

the purpose of establishing the authority of my designated agent to act in accordance with this Power of

Attorney.

[_____] I wish to have this Power of Attorney become effective on the following date:

[_____] I wish to have this Power of Attorney end on the following date:

[_____] I wish to have this Power of Attorney continue in force until revoked by me or until my death,

whichever occurs first.

10.

THIRD PARTY PROTECTION.

Third parties may rely upon the validity of this Power of Attorney or a copy and the representations of my

agent as to all matters relating to any power granted to my agent, and no person or agency who relies upon

the representation of my agent, or the authority granted by my agent, shall incur any liability to me or my

estate as a result of permitting my agent to exercise any power unless a third party knows or has reason to

know this Power of Attorney has terminated or is invalid.

11.

RELEASE OF INFORMATION.

I agree to, authorize and allow full release of information, by any government agency, business, creditor

or third party who may have information pertaining to my assets or income, to my agent named herein.

12. SIGNATURE AND ACKNOWLEDGMENT. YOU MUST DATE AND SIGN THIS POWER OF

ATTORNEY. THIS POWER OF ATTORNEY WILL NOT BE VALID UNLESS IT IS ACKNOWLEDGED

BEFORE A NOTARY PUBLIC.

I am the above-named "Principal", and I sign my name to this Power of Attorney in Las Vegas, Nevada.

(Name:)

Date

Nevada Statutory Power Of Attorney Form Page 5