Limited Power Of Attorney Form Page 2
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1
2(11)
Employment of Agents and Service Professionals
(12)
Personal Relationships and Affairs
(13)
Other:
3.
The undersigned being first duly sworn says:
(Initial)
(
)
I also give to such person full power to appoint another to act as my attorney-in-
fact and full power to revoke such appointment.
(
)
This power shall not be affected by my subsequent incapacity or mental capacity.
(
)
The powers herein granted shall be deemed continuing and relate as fully to any
property which I may hereafter acquire as to any property which I may now own
and may be exercised repeatedly. The powers herein granted shall exist to their
full extent in any jurisdiction, including any State of the United States of America
and in any foreign country where such powers may be necessary. The powers
herein granted shall exist to their full extent regardless of my whereabouts within
or without the United States of America;
(
)
This Power of Attorney has been provided to me at the moment of execution in
both the English language and the Spanish language. I am able to read and
understand the Spanish language and by being provided the English and Spanish
versions of this Power of Attorney, I have fully understood every term and
condition contained herein.
I declare under penalty of perjury under the laws of the State of Tennessee that the
foregoing is true and correct.
STATE OF TENNESSEE)
COUNTY OF
)
Date:
Principal
The Principal,
, personally appeared
before me this
day of
, 20
.
NOTARY PUBLIC
My commission expires:
2
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