Power of Attorney Form

POWER OF ATTORNEY

This Power of Attorney is made on by the undersigned Principal and appoints the Agent named below.

Principal Name:   Principal Address:

Agent Name:   Agent Address:

RECITALS

WHEREAS, the Principal desires to appoint an Agent to act on the Principal's behalf in matters described in this instrument and to confer upon the Agent the powers set forth below; and

WHEREAS, the Principal acknowledges that the Agent will have broad authority and that third parties may rely upon the Agent's actions taken within the scope of authority granted herein; and

WHEREAS, the Principal intends that this document be a durable Power of Attorney and remain effective notwithstanding any subsequent disability or incapacity of the Principal, except as limited herein.

NOW, THEREFORE, the Principal hereby grants to the Agent the powers and authority set forth below:

1. APPOINTMENT

The Principal hereby appoints the Agent named above to act as attorney-in-fact for the Principal in all matters described in this instrument. The Agent's authority is fiduciary in nature and shall be exercised in the Principal's best interests.

2. GRANT OF GENERAL AUTHORITY

Subject to any limitations set forth in this document, the Agent is authorized to act for the Principal with respect to the following categories of powers. The Agent may exercise any of the following powers in the name of, for the benefit of, and on behalf of the Principal:

Real Property Transactions — buy, sell, lease, mortgage, manage, and encumber real estate interests.

Personal Property Transactions — acquire, transfer, insure, and maintain tangible and intangible personal property.

Banking and Financial Transactions — open, close, and operate accounts; sign checks; endorse and negotiate instruments.

Business Interests — manage, sell, or dissolve business interests and execute related documents.

Tax Matters — prepare, sign, and file tax returns and represent the Principal before tax authorities.

Benefits and Insurance — apply for, receive, and manage benefits, insurance claims, and payments.

3. SPECIAL INSTRUCTIONS

4. EFFECTIVE DATE AND DURATION

This Power of Attorney shall become effective on the date specified below and shall remain in effect until revoked in accordance with Section 5 or by operation of law.

Effective Date:   Duration (if limited):

5. REVOCATION

The Principal may revoke this Power of Attorney at any time by providing written notice of revocation to the Agent and to any third parties relying on this Power of Attorney. Revocation is effective upon receipt by the Agent or the third party.

6. AGENT'S DUTIES AND STANDARD OF CARE

The Agent shall act in accordance with the Principal's reasonable expectations, consistent with the Principal's best interests. The Agent shall keep accurate records of all transactions made on behalf of the Principal and shall provide an accounting to the Principal upon request.

7. LIABILITY AND INDEMNIFICATION

The Agent is not liable for losses resulting from actions taken in good faith under this Power of Attorney. The Principal agrees to indemnify and hold the Agent harmless from any liability, loss, or expense incurred as a result of good faith actions taken pursuant to this Power of Attorney, except for gross negligence or willful misconduct.

8. THIRD-PARTY RELIANCE

Any person, including financial institutions and governmental agencies, may rely upon a copy of this Power of Attorney and is entitled to rely on the representations of the Agent as to all matters regarding the authority granted herein until such person receives actual notice of revocation.

9. COMPENSATION AND EXPENSES

The Agent shall be entitled to reimbursement for reasonable expenses incurred on behalf of the Principal. Compensation for the Agent's services (if any) shall be:

No compensation; reimburse only reasonable expenses.    Compensation as agreed: $

10. NOTICES

Any notice required or permitted under this Power of Attorney shall be in writing and shall be delivered to the Principal or Agent at their respective addresses set forth above or at such other address as either party shall provide in writing.

11. GOVERNING LAW

This Power of Attorney shall be governed by and construed in accordance with the laws of the state specified below.

12. ENTIRE AGREEMENT

This instrument constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes any prior oral or written powers of attorney executed by the Principal, unless explicitly incorporated herein.

13. SEVERABILITY

If any provision of this Power of Attorney is determined to be invalid or unenforceable, the remaining provisions shall remain in full force and effect to the maximum extent permitted by law.

14. AMENDMENTS AND WAIVER

Any amendment to or waiver of any provision of this Power of Attorney must be in writing and signed by the Principal. No failure or delay by a party in exercising any right under this Power of Attorney shall operate as a waiver of that right.

15. COUNTERPARTS

This 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.

16. ACKNOWLEDGEMENT BY AGENT

The Agent acknowledges the duties imposed by this Power of Attorney and agrees to act in accordance with its terms. The Agent affirms that the Agent will act only within the scope of authority granted and will decline to act if doing so would violate law or the Agent's fiduciary duties.

Agent Acceptance: I accept appointment as Agent under this Power of Attorney.

NOTARIAL AND ADDITIONAL INFORMATION

If notarization or additional witnessing is required by law or requested by third parties, the Principal and Agent may obtain such acknowledgment separately. The presence or absence of a notary does not affect the validity of the powers granted herein under applicable law.

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