Special Power of Attorney Form

Please fill out this form to authorize another person to act on your behalf.

KNOW ALL MEN BY THESE PRESENTS

I, [Full Name], of legal age, residing at [Address] , hereby appoint [Agent Name], of legal age, residing at [Agent's Address] , as my true and lawful attorney-in-fact to act in my name, place, and stead in connection with the following matters:

• To manage and transact financial matters, including banking and payments.

• To buy, sell, lease, or manage real estate or property.

• To sign legal documents and agreements on my behalf.

• To represent me in government agencies, institutions, or legal proceedings.

• To make medical decisions on my behalf.

DURATION OF AUTHORITY

Effective immediately and valid until revoked. I hereby ratify and confirm all lawful acts performed by my attorney-in-fact within the scope of authority granted in this document.

SIGNED this [Day]day of [Month], [Year].

Principal Signature:

Name:

Attorney-in-Fact Signature:

Name:

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