INSERT FULL NAME/S OF PERSON/S GIVING THE POWER OF ATTORNEY
IF MARRIED, INSERT FULL NAMES OF HUSBAND/ WIFE
INSERT COMPLETE ADDRESS IN THE USA
INSERT FULL NAME/S OF YOUR AGENT/S
INSERT COMPLETE ADDRESS OF AGENT/S
INDICATE THE SPECIFIC ACT/S YOUR AGENT/ATTORNEY IN FACT WILL DO.
THE MORE SPECIFIC, THE BETTER.
YOU CAN ALSO INDICATE HERE THE DURATION OF THE VALIDITY OF THIS
SPECIAL POWER OF ATTORNEY
INSERT DAY IN NUMBERS
INSERT MONTH
CITY, COUNTY, STATE YOU SIGNED THIS DOCUMENT
INSERT FULL NAME HERE
INSERT FULL NAME HERE; INDICATE HUSBAND OR WIFE