Special Power Of Attorney - Oklahoma State University printable pdf download

SPECIAL POWER OF ATTORNEY

Know all people and corporations by this Special Power of Attorney that I,

_____________________________________, OSU CWID__________________,

desiring to execute a SPECIAL POWER OF ATTORNEY, have made, constituted and

appointed, and by these presents do make, confirm, constitute and appoint my designee

named below my Attorney-in-Fact to act for me, on my behalf and in my name, place,

and stead to conduct all business on my behalf with reference to employment related

benefits or pay matters that I enjoy through my employment relationship with Oklahoma

State University, unless specifically excluded by me as indicated below. Such authority

granted herein includes performing all necessary acts in the execution of the powers

stated above with the same validity as I could effect if personally present, making any

changes in insurance coverage, benefits plan enrollment, or compensation arrangements

for myself and any other persons who are or may be eligible to be enrolled in any benefits

plan(s) offered to me as a result of my employment with Oklahoma State University,

unless specifically excluded by me as indicated below. Further, I affirm that any act or

thing lawfully done hereunder by my said attorney shall be binding on myself and my

heirs, legal and personal representatives, and assigns.

It is necessary for all business transacted hereunder for me or my account to be transacted

in my name, and that all instruments executed by my attorney for the purpose of carrying

out the foregoing powers shall contain my name, followed by that of my said attorney

and the designation “Attorney-in-fact.”

All rights, powers, and authority of said Attorney-in-Fact to exercise any and all of the

rights and powers herein granted shall commence and be in full force and affect on

_______________________________and such rights, powers, and authority shall remain

in full force and effect thereafter until_______________________________ (insert

Further Notice if an expiration date is not desired).

SPECIAL POWER OF ATTORNEY DESIGNEE

Name: ______________________________________________________

Address: ____________________________________________________

City/State/ Zip: _______________________________________________

Telephone Number: ___________________________________________

E-mail: ______________________________________________________

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2012

Special Power Of Attorney - Oklahoma State University