I, ________________________________(Principal's name)
being of sound mind and legal capacity, do hereby appoint
as my true and lawful attorney in fact, to act for me in my name, place, and stead, and on my behalf to do and perform the following:
(List agent's powers here, such as the power to buy or sell stock or real estate, write checks, etc.)
The following property, interests, or rights shall be subject to this Power of Attorney:
(Identify assets subject to agent's authority.)
This Power of Attorney shall be effective on the date of ____________, 20___.
This Power of Attorney shall remain in effect in the event that I should become or be declared disabled, incapacitated, or incompetent.
This Power of Attorney shall terminate on the date of ____________, 20____, unless I have revoked it sooner. I may revoke this Power of Attorney at any time and in any manner.
My agent shall be paid compensation for services pursuant to this Power of Attorney as follows:
(Identify compensation agent will receive, if any.)
This Power of Attorney shall be governed by the laws of the State of __________________.
In Witness Whereof, I have signed this Power of Attorney of my own free will.
Agreed to and Accepted by:
Subscribed and sworn to before me on this _____ day of _____________, 20____.