Personal Authorization Form
Personal Authorization Form
Please read and complete this form carefully to authorize another person or entity to act on your behalf.
Authorizing Party (Grantor) Information
Name
Date of Birth
Phone Number
Address
Authorized Party (Grantee) Information
Name
Relationship to Grantor
Phone Number
Address
Authorization Details
Purpose of Authorization
Effective Date
Expiration Date
Specific Powers Granted (if applicable)
Authorization Statement
I, [Your Name], hereby authorize
Signature of Grantor
Name:
Date:
Witness Information (if required)
Name
Signature of Witness
Name:
Date:
By submitting this form, I confirm that I have read and understood the above authorization and grant the powers described herein.
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