Fillable DURABLE SPECIAL POWER OF ATTORNEY

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DURABLE SPECIAL POWER OF ATTORNEY

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© 2012 by O’Steen & Harrison, PLC
DURABLE SPECIAL POWER OF ATTORNEY
PRINCIPAL:
NAME
PLACE OF RESIDENCE
DATE OF BIRTH
ATTORNEY-IN-FACT/AGENT:
NAME
PLACE OF RESIDENCE
DATE OF BIRTH
Principal hereby constitutes and appoints Attorney-in-Fact to act in the name and place of Principal, and as the true
and lawful agent for Principal to perform the following acts:
Principal gives and grants to Attorney-in-Fact full power and authority to do and perform every act and thing
whatsoever requisite, necessary or appropriate to be done in and about the premises as fully to all intents and
purposes as Principal might or could do if personally present, hereby ratifying all that Attorney-in-Fact shall lawfully
do or cause to be done by virtue of this Special Power of Attorney.
This Power of Attorney is not affected by subsequent disability or incapacity of the Principal, nor is it affected by how
much time has elapsed since its execution.
Signature of Principal
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© 2012 by O’Steen & Harrison, PLC
I, ____________________________________ , the Principal, sign my name to this Power of
Attorney this _________ day of ______________________, ___________, and, being first duly sworn, do declare to
the undersigned authority that I sign and execute this instrument or direct another to sign for me as my Power of
Attorney, and that I sign it willingly, or willingly direct another to sign for me, that I execute it as my free and voluntary
act for the purposes expressed in the Power of Attorney and that I am eighteen years of age or older, of sound mind
and under no constraint or undue influence.
Signature of Principal
I, _________________________________
, the Witness, sign my name to the foregoing Power
of Attorney this _________ day of ______________________, ___________, and, being first duly sworn, do declare
to the undersigned authority that the Principal signs and executes this instrument as his/her Power of Attorney and
that he/she signs it willingly, or willingly directs another to sign for him/her, and that I, in the presence and hearing of
the Principal, sign this Power of Attorney as witness to the Principal's signing and that to the best of my knowledge
the Principal is eighteen years of age or older, of sound mind and under no constraint or undue influence.
Signature of Witness
STATE OF
County of
ss.
Subscribed, sworn to and acknowledged before me by
________________________________ _______ ,
the
Principal, and subscribed, sworn to and acknowledged before me by
___________________________________
,
the Witness, this
_______ day of ________________________, ___________.
______________________________________
(Notary Seal)
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DURABLE SPECIAL POWER OF ATTORNEY

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Completed 24 August 2021

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