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Limited Power of Attorney Template


Limited Power of Attorney Template Page 2
Limited Power of Attorney Template
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2
POWER OF ATTORNEY – LIMITED
(Note: Rules regarding legal sufficiency of a power of attorney vary by state. Please consult your
state rules and have the form reviewed by a lawyer in your state regarding additional language,
witness signatures, and notary requirements.)
1. I, [INSERT NAME and ADDRESS] the undersigned hereby make, constitute and appoint
[INSERT NAME and ADDRESS] as my attorney-in-fact who shall have full power and
authority to undertake and perform only the following acts on my behalf:
[INSERT SPECIFIC MATTERS FOR WHICH POWER OF ATTORNEY IS BEING USED]
(i) _______________________________________________________________
(ii) _______________________________________________________________
(iii) _______________________________________________________________
2. This Power of Attorney is effective immediately and will continue until I revoke it.
[OR]
2. This Power of Attorney shall be effective on the date of [INSERT DATE].
This Power of Attorney shall terminate on the date of [INSERT DATE], unless I revoke it
sooner. I may at any time or by any manner revoke this Power of Attorney.
3. This Power of Attorney [WILL OR WILL NOT] continue to be effective even though I
become incapacitated.
4. This Power of Attorney shall be governed by the State of [INSERT STATE].
Signed this __________ day of ______________________, __________.
________________________________________
(Your signature)
________________________________________
(Your Social Security number)
State of ________________________, County of _________________________, USA
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Limited Power of Attorney Template