Power Of Attorney Form - Wisconsin (Page 2 of 2) in pdf

Power Of Attorney Form - Wisconsin Page 2

This power of attorney shall take effect on the above mentioned effective date and will

continue indefinitely or until revoked by me or by my death.

I do hereby grant my attorney in fact complete authority to act in any reasonable manner that

is necessary to execute the above mentioned powers that are granted.

I agree that any third party who is given a copy of this power of attorney may act relying on it. I

also agree that revocation of this power of attorney is effective as to a third party only upon

receipt of actual notice by the third party. I agree to indemnify the third party for any loss that

may be suffered while carrying out this power of attorney.

Signature & Acknowledgment

Wisconsin

This contract shall be governed by the laws of the State of

in __________ County and any

applicable Federal Law.

__________________________________________________________

Date____________

Signature

By accepting this appointment and acting under it, I the attorney-in-fact (“Agent”) do hereby assume the

legal responsibilities of an agent.

_____________________________________________________________________Date____________

Signature of Attorney-in-Fact

WITNESS #1) _________________________________

WITNESS #2) _________________________________

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Power Of Attorney Form - Wisconsin Page 2