Statutory Durable Power Of Attorney Form Page 3
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3If any agent named by me dies, becomes legally disabled, resigns, or refuses to act, I name the
following (each to act alone and successively, in the order named) as successor(s) to that agent:
_______________________________________________________.
Signed this ______ day of __________, 20___.
__________________________________
(your signature)
State of _______________________
County of ______________________
This document was acknowledged before me on __________________________(date) by
_______________________________ (name of principal).
___________________________________
(signature of notarial officer)
(Seal, if any, of notary)
___________________________________
(printed name)
My commission expires: _______________
THE ATTORNEY IN FACT OR AGENT, BY ACCEPTING OR ACTING UNDER THE
APPOINTMENT, ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES
OF AN AGENT.
STATUTORY DURABLE POWER OF ATTORNEY
PAGE 3
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