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Fill and Sign the Georgia Statutory Financial Power of Attorney Instructions Form

Fill and Sign the Georgia Statutory Financial Power of Attorney Instructions Form

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DURABLE POWER OF ATTORNEY (For Limited Purpose of Executing Division Orders and Transfer Orders) State: County: Principal: (Name and Address) Agent/Attorney in Fact: (Name and Address) Effective Date: Principal, named above, appoints and constitutes Agent, named above, as Principal's Agent and Attorney in Fact, for the limited purpose of executing division orders, transfer orders, and all other directions for payment on Principal's interests in oil, gas, and other mine rals in the lands located in the county and state named above, described as follows: (Description of Lands that are Subject of Power of Attorney) This Power of Attorney shall be deemed effective as of the Effective Date stated a bove, until revoked in writing by Principal. This Power of Attorney is deemed a durable Power of Attorney and shall survive the disability or incapacity of Principal. This Power of Attorney is signed by Principal as of the date of acknowledgment of Principal's signature below, but is effective for all purposes as of the Effective Date stated above. Principal

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