Legal Proxy Document

LEGAL PROXY DOCUMENT

This Legal Proxy Document is executed as of by Principal Name: of Address: and Agent Name (Proxy): of Address: .

RECITALS

WHEREAS, Principal is a competent adult with full legal capacity to execute this instrument and desires to appoint a representative to act on Principal's behalf with respect to legal matters as set forth below;

WHEREAS, Agent is willing to serve as Principal's legal proxy and to exercise the authority granted herein in good faith and in a manner consistent with Principal's objectives and best interests;

WHEREAS, the parties intend that the authority conferred by this Legal Proxy Document be durable, subject to the terms and limitations herein, and relied upon by third parties dealing with the Agent in good faith;

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the parties agree as follows:

1. APPOINTMENT

Principal hereby appoints Agent as Principal's true and lawful attorney-in-fact and legal proxy (the "Agent") with authority to act in Principal's name, place and stead to exercise the powers described in Section 2 below. The Agent's authority is fiduciary in nature and shall be exercised for the benefit of the Principal.

2. POWERS GRANTED

The Agent is authorized to perform any and all acts that Principal could lawfully perform related to legal matters, including but not limited to the following specific powers (each power may be exercised singly, cumulatively, and without prior court approval):

Represent Principal in litigation, arbitration, administrative proceedings, or dispute resolution processes, including engaging counsel, filing claims, defenses, and appeals, and settling or dismissing actions.

Execute, acknowledge, deliver and record pleadings, contracts, releases, consents, powers of attorney, and other instruments necessary to prosecute or defend claims and to effectuate settlements.

Obtain, inspect, and copy legal, financial, governmental and other records and documents relevant to any claim or defense, including sealed records where permitted by law.

Negotiate, execute and receive the proceeds of settlements, including the execution of releases, and to accept or refuse settlement offers on Principal's behalf.

Take actions related to real property interests to the extent necessary to prosecute or defend claims, including mortgages, liens, and conveyances, subject to the limitations in Section 3.

Handle tax matters to the extent incidental to legal claims, including filing claims for refunds and executing tax-related documents.

3. LIMITATIONS ON AUTHORITY

The authority granted to the Agent shall not include the power to make gifts of Principal's assets, create or modify Principal's testamentary dispositions, or make healthcare decisions, except to the extent that such actions are necessary and expressly authorized in writing below. Any attempt by Agent to exercise a power that is expressly prohibited renders that act voidable by Principal.

Specific prohibitions (check if applicable):
Agent shall not make gifts on Principal's behalf.
Agent shall not alter Principal's will or testamentary dispositions.
Agent shall not transfer or encumber real property without Principal's prior written consent.

4. EFFECTIVE DATE; TERM; TERMINATION

This Legal Proxy Document shall become effective on the date indicated in the opening paragraph and shall continue in effect until unless earlier revoked in writing by Principal or terminated as provided herein. If no termination date is provided, this proxy shall remain in effect until revoked.

Principal may revoke this appointment at any time by delivering written notice of revocation to Agent in accordance with the Notices provision below. Revocation is not effective as to third parties who act in good faith and without actual knowledge of revocation prior to such third parties' reliance.

5. THIRD-PARTY RELIANCE; AUTHENTICATION

Third parties, including courts, governmental agencies, financial institutions, and opposing counsel, may rely upon a copy of this Legal Proxy Document and the authority of the Agent until such third parties have actual knowledge of its revocation or termination. Third parties may require reasonable proof of the Agent's identity and authority, including a certified copy of this document.

6. REPRESENTATIONS AND WARRANTIES

Principal represents and warrants that Principal has the legal capacity to enter into this Legal Proxy Document; that the execution and delivery of this document is free of undue influence; and that no legal proceeding is pending that would restrict the delegation of the powers granted herein. Agent represents and warrants that Agent will act in good faith, in Principal's best interests, and in accordance with applicable law.

7. INDEMNIFICATION

Principal agrees to indemnify and hold harmless Agent from and against any and all losses, claims, liabilities, damages, costs and expenses (including reasonable attorneys' fees) arising out of or related to actions taken by Agent within the scope of authority granted in this document, except to the extent such losses result from Agent's gross negligence or willful misconduct.

8. NOTICES

All notices required or permitted under this Legal Proxy Document shall be in writing and delivered personally, by certified mail (return receipt requested), or by nationally recognized overnight delivery service to the addresses below (or to such other address as either party may designate by notice):

9. GOVERNING LAW

This Legal Proxy Document shall be governed by and construed in accordance with the laws of the jurisdiction of , without regard to its conflicts of law principles.

10. ENTIRE AGREEMENT; SEVERABILITY

This document constitutes the entire agreement between Principal and Agent with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements and understandings, whether written or oral. If any provision of this Legal Proxy Document is held invalid or unenforceable, such invalidity shall not affect the remaining provisions, which shall continue in full force and effect.

11. AMENDMENTS; WAIVER; COUNTERPARTS

This Legal Proxy Document may be amended or revoked only by a signed writing executed by Principal and delivered to Agent. No waiver of any provision of this document shall be effective unless in writing and signed by the party against whom enforcement is sought. This document may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument.

12. MISCELLANEOUS

Principal acknowledges that Principal has had the opportunity to consult with independent counsel and that Principal signs this Legal Proxy Document voluntarily and with full knowledge of its contents. Agent accepts the appointment and agrees to act in accordance with the terms of this document.

IN WITNESS WHEREOF, the parties have executed this Legal Proxy Document as of the date first written above.

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