SPECIAL POWER OF ATTORNEY

I, ______________________, of ___________________, hereby appoint ___________________________ of __________________________, as my attorney in fact to act in my capacity to do 
any and all of the following:






The rights, powers, and authority of my attorney in fact to exercise any and all of the rights and powers herein granted shall commence and be in full force and effect on 
___________________, 20___, and shall remain in full force and effect until __________________________ or unless specifically extended or rescinded earlier by either party.

Dated _________________________, 20___.

__________________________ 


STATE OF ___________________ 

COUNTY OF __________________ 

BEFORE ME, the undersigned authority, on this __ day of _______________, 20__, personally appeared ______________________ to me well known to be the person described in and 
who signed the Foregoing, and acknowledged to me that he executed the same freely and voluntarily for the uses and purposes therein expressed.

WITNESS my hand and official seal the date aforesaid.

____________________________ 
   NOTARY PUBLIC

My Commission Expires:______