Legal Authorization Form

LEGAL AUTHORIZATION FORM

This Legal Authorization Form (the "Authorization") is made and entered into as of by and between Principal Name: , with Mailing Address: ; and Agent Name: , with Mailing Address: .

RECITALS

WHEREAS, Principal desires to authorize Agent to act on Principal's behalf in certain matters described herein and to receive, review, and execute documents and instruments within the scope set forth below; and

WHEREAS, Agent has agreed to accept such appointment and to act as Principal's authorized representative subject to the terms, limitations, and conditions of this Authorization; and

WHEREAS, the parties intend that this Authorization constitute a legally binding delegation of authority as provided herein.

NOW, THEREFORE

In consideration of the mutual covenants and agreements set forth below, and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

1. APPOINTMENT; SCOPE OF AUTHORITY

1.1 Appointment. Principal hereby appoints Agent as Principal's true and lawful agent and attorney-in-fact to act in Principal's name, place and stead to perform the acts described in Section 1.2, subject to the limitations in Section 2.

1.2 Specific Authorities. Agent is authorized, without limitation except as expressly provided herein, to:

• Access and obtain copies of Principal's records, accounts, and documentation from third parties and public or private entities.
• Execute, deliver, amend, and withdraw documents and instruments necessary to effectuate transactions on Principal's behalf.
• Receive, endorse, and deposit funds payable to Principal and to arrange for disbursements as directed in writing by Principal.
• Negotiate, settle, and resolve claims and disputes as reasonably necessary to protect Principal's interests.

The foregoing authorities include the power to sign and deliver any document, agreement, receipt, release, or other instrument relating to the matters within the scope of this Authorization.

2. LIMITATIONS ON AUTHORITY

2.1 Exclusions. Notwithstanding Section 1, Agent shall have no authority to: (a) make or amend Principal's will; (b) make gifts on behalf of Principal; (c) execute any document that would transfer Principal's ownership interest in real property unless expressly consented to in a separate written instrument; or (d) act in any matter where such action would constitute a criminal or fraudulent act.

2.2 Special Instructions. Additional limitations or special instructions (if any):

3. TERM; REVOCATION

3.1 Term. This Authorization shall commence on the Effective Date set forth above and shall remain in effect until , unless earlier revoked in accordance with Section 3.2.

3.2 Revocation. Principal may revoke this Authorization at any time by providing written notice of revocation to Agent at the address provided in Section 8. Revocation shall be effective upon receipt by Agent, but shall not affect any actions taken by Agent prior to receipt of the revocation.

4. AGENT'S DUTIES; STANDARD OF CARE

Agent shall act in good faith, with reasonable care, and in the best interests of Principal when exercising the authority granted herein. Agent shall keep accurate records of all transactions effected under this Authorization and shall provide copies of such records to Principal upon reasonable request.

5. COMPENSATION AND EXPENSES

Unless otherwise agreed in writing, Agent shall be entitled to reimbursement for reasonable out-of-pocket expenses incurred in the performance of duties hereunder. Any compensation payable to Agent must be expressly set forth in a separate writing signed by Principal.

6. REPRESENTATIONS AND WARRANTIES

Each party represents and warrants that it has full power and authority to enter into this Authorization, that the person signing on its behalf is duly authorized to do so, and that the execution and delivery of this Authorization will not violate any agreement to which that party is bound.

7. INDEMNIFICATION; LIMITATION OF LIABILITY

Principal agrees to indemnify, defend, and hold harmless Agent from and against any and all claims, liabilities, losses, damages, and expenses, including reasonable attorneys' fees, arising from Agent's performance under this Authorization, except to the extent such claims result from Agent's gross negligence or willful misconduct. Agent shall not be liable for any loss resulting from a good-faith action taken under this Authorization.

8. NOTICES

All notices required or permitted under this Authorization shall be in writing and delivered personally, by certified mail (return receipt requested), or by nationally recognized courier service to the addresses set forth below or such other address as a party may designate by written notice to the other party.

9. AMENDMENT; WAIVER; COUNTERPARTS

This Authorization may be amended or modified only by a written instrument signed by both Principal and Agent. No waiver of any provision hereof shall be effective unless in writing and signed by the party against whom enforcement is sought. This Authorization 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.

10. GOVERNING LAW; SEVERABILITY; ENTIRE AGREEMENT

This Authorization shall be governed by and construed in accordance with the laws of the state specified by Principal for governing law: , without regard to its conflict of laws principles. If any provision of this Authorization is held invalid or unenforceable, the remaining provisions shall continue in full force and effect. This Authorization constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior oral or written agreements.

11. ENTITY TYPE AND AUTHORITY OF SIGNATORIES

Principal represents that the undersigned has full authority to execute this Authorization on behalf of Principal. Indicate entity type for Principal:

Individual    Corporation    Limited Liability Company (LLC)    Other:

Agent represents that the undersigned has full authority to accept this appointment on behalf of Agent (if signing in a representative capacity). Indicate entity type for Agent:

Individual    Corporation    Limited Liability Company (LLC)    Other:

12. AUTHORIZED ACTIONS (CHECK ALL THAT APPLY)

Access and obtain records    Execute documents and instruments    Receive and deposit funds    Negotiate and settle claims    Delegate to subagents where necessary

13. RECORDS AND ACCOUNTING

Agent shall maintain complete and accurate records of all actions taken and funds received or disbursed on behalf of Principal and shall make such records available to Principal upon reasonable request. Such records shall be retained for a period of not less than three (3) years following the termination of this Authorization unless a longer period is required by law.

SIGNATURES

The parties have executed this Authorization as of the dates set forth below. The individuals signing below warrant that they are authorized to sign on behalf of the party for whom they sign.

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