Limited Power Of Attorney Page 2
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2II. EFFECTIVE DATE AND TERMINATION
A. This power of attorney shall be effective: (select appropriate provision)
as of the date it is signed.
as of the _____ day of ___________________, 2_____.
upon the determination that I am disabled or incapacitated, or no longer capable of managing my affairs
prudently. My disability or incapacity, for this purpose, may be established by the certificate of a qualified
physician stating that I am unable to manage my affairs.
B. My disability or incompetence (select appropriate provision): (shall) (shall not) affect or terminate this Power of
Attorney.
C. This Power of Attorney shall terminate: (select appropriate provision)
upon my incapacity.
upon the _____ day of _____________________, 2_____.
upon the execution and recordation with the Recorder' s Office of the County where the Real
Estate
is located a written revocation hereof.
III. RATIFICATION AND INDEMNIFICATION
I/We hereby ratify and confirm that all my attorney-in-fact shall do by virtue hereof. Further, I/We agree to indemnify
and hold harmless any person who, in good faith, acts under this Power of Attorney or transacts business with my
attorney-in-fact in reliance upon this Power, without actual knowledge of its revocation.
IN WITNESS WHEREOF,
I/We have hereunto set my/our hand(s) and seal(s) this _____ day of
_____________________________, 2_____.
____________________________________________
________________________________________
Printed: _____________________________________
Printed:__________________________________
STATE OF INDIANA
SS:
COUNTY OF _______________
Before me, a Notary Public in and for said County and State, personally appeared _________________________
____________________________________ _____________________________________________________
and __________________________________________________________________ who acknowledged the execution
of the foregoing Power of Attorney, and who, having been duly sworn, stated that any representations therein contained
are true.
WITNESS my hand and Notarial seal, this _____day of ______________________, 2____.
___________________________________________, Notary Public
Printed:____________________________________
My Commission Expires: _____________________
My County of Residence:______________
This instrument was prepared by _______________________________________________________________
I affirm, under the penalties for perjury, that I have taken reasonable care to redact each Social Security number in this
document, unless required by law.
Return Document after recording to: (address) ______________________________________________________
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