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LIMITED POWER OF ATTORNEY
Specify Powers
 
Please Complete All Applicable Sections
Select County:
Your Name:
Address:
City: 
State:   Zip: 
Phone:
Email:
Date of Birth:
U.S. Citizen? Yes No
Other Names:
Are you known by any other names.
Gender: Male  Female
Name of Spouse:
Provide the Full name of your spouse.
m
 Attorney in Fact
Name:
Name of the person who will be the true and lawful agent
Address:
City:   
State:   Zip: 
Phone:
The Power of Attorney is
Durable  Non Durable
Start Date:
Terminates on:
Specify Powers
Specify Powers:
Specify Limits:
Examples: Collection of Debts
Endorsements
Executing Government Vouchers
Depositing Money and Other Property
Borrowing Money
Acquisition of Property
Recovering Possession of Property
Litigation
Tax Returns
Automobiles
Disposition of Property
h
Optional Items
Describe Other Provisions desired:
 
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