Interim Power of Attorney Document

INTERIM POWER OF ATTORNEY DOCUMENT

This Interim Power of Attorney is executed on by and between Principal Name: of Principal Address: (hereinafter "Principal") and Agent Name: of Agent Address: (hereinafter "Attorney-in-Fact").

RECITALS

WHEREAS, Principal anticipates a temporary inability to attend to certain personal, financial or legal affairs during an interim period and desires to appoint an Attorney-in-Fact to act on Principal's behalf for limited matters as set forth herein; and

WHEREAS, Attorney-in-Fact has agreed to serve as an interim attorney-in-fact and to exercise the powers granted under the terms and subject to the limitations contained in this instrument; and

WHEREAS, Principal intends that this instrument be effective only for the interim period specified below and that Principal reserves the right to revoke or modify this instrument as provided herein.

NOW, THEREFORE, in consideration of the foregoing recitals and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, Principal grants Attorney-in-Fact the powers and imposes the duties set forth below.

1. GRANT OF INTERIM AUTHORITY

Principal hereby appoints Attorney-in-Fact as Principal's true and lawful attorney-in-fact to act in Principal's name, place and stead to perform the following acts and transactions, subject to the limitations and conditions of this instrument. The authority granted is fiduciary in nature and is to be exercised in good faith, with reasonable care, and in Principal's best interests.

2. SCOPE OF AUTHORITY

Attorney-in-Fact is authorized to perform the following categories of acts on behalf of Principal only to the extent indicated by the checked boxes and subject to any special instructions included in Section 4:

Financial transactions, including but not limited to managing bank accounts, endorsing and depositing checks, paying bills, and accessing safe deposit boxes.

Real property transactions, including leasing, managing, and collecting rents, and executing documents necessary for the care, maintenance and disposition of real property owned or controlled by Principal.

Health care and medical-related decisions to the extent permitted under applicable law and subject to any advance directive provided by Principal.

Tax matters, including preparing, signing, and filing federal, state and local tax returns and responding to tax authority inquiries.

3. EFFECTIVE DATE; DURATION; INTERIM NATURE

This Interim Power of Attorney is effective beginning on and shall continue in full force and effect until unless earlier revoked by Principal in accordance with Section 9. The parties acknowledge and intend that this instrument is interim in character and meant to cover a temporary need.

4. LIMITATIONS AND SPECIAL INSTRUCTIONS

Attorney-in-Fact shall not: (a) make or revoke a will; (b) make gifts of Principal's property, except as expressly authorized in writing below; (c) commit Principal to sale or transfer of the primary residence unless expressly authorized; (d) take any action that contravenes an advance directive previously executed by Principal.

5. DUTIES, STANDARD OF CARE, AND ACCOUNTABILITY

Attorney-in-Fact shall act loyally and prudently for the Principal's benefit, avoid conflicts of interest, keep accurate records of all actions taken under this instrument, and, upon reasonable request, provide accountings to Principal or to any court having jurisdiction. Attorney-in-Fact shall not commingle Principal's funds with the Attorney-in-Fact's personal funds.

6. DELEGATION; SUBSTITUTION

Attorney-in-Fact may engage agents, attorneys, accountants and other advisors as reasonably necessary to perform duties under this instrument. Any delegation shall not relieve Attorney-in-Fact of ultimate responsibility for actions taken by delegates, except where otherwise provided by law.

7. THIRD PARTY RELIANCE

Third parties dealing with Attorney-in-Fact may rely upon a copy of this instrument and any certificate of authority delivered by Attorney-in-Fact. Third parties are entitled to rely on a facially valid power of attorney and are not required to inquire into the existence of the Principal's incapacity or any internal restrictions not apparent on the face of this document.

8. COMPENSATION AND EXPENSES

Attorney-in-Fact shall be entitled to reimbursement of reasonable out-of-pocket expenses incurred on behalf of Principal. Indicate whether compensation is permitted and the rate or method:

9. REVOCATION AND TERMINATION

This Interim Power of Attorney may be revoked by Principal by delivering written notice of revocation to Attorney-in-Fact or by executing a subsequent power of attorney. This instrument shall automatically terminate upon occurrence of any event expressly provided for in Section 3 or upon Principal's death, except as otherwise required by law.

10. BOND

No bond shall be required of Attorney-in-Fact unless a court of competent jurisdiction orders otherwise. If a bond is required, the cost shall be paid from Principal's assets.

11. NOTICES

12. AMENDMENTS; WAIVER

This instrument may be amended or supplemented only by a written instrument executed by Principal. No failure or delay by any party in exercising any right under this instrument shall operate as a waiver of that right.

13. GOVERNING LAW

This Interim Power of Attorney shall be governed by and construed in accordance with the laws of the state specified for the Principal's residence at the time of execution. Any disputes arising under this instrument shall be resolved in a court of competent jurisdiction within that state.

14. ENTIRE AGREEMENT; SEVERABILITY

This instrument contains the entire agreement between the parties with respect to the subject matter hereof. If any provision of this document is held invalid or unenforceable, the remaining provisions shall remain in full force and effect to the maximum extent permitted by law.

15. COUNTERPARTS; CERTIFICATION

This Interim Power of Attorney may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument. Principal certifies that Principal is of legal age and of sound mind and has the capacity to execute this instrument.

16. ACKNOWLEDGMENT

By signing below, Principal and Attorney-in-Fact acknowledge that they have read and understand the terms of this Interim Power of Attorney and accept the duties and responsibilities described herein.

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