Fill and Sign the Power of Attorney Georgias Southern Judicial Circuit Form

Special Durable Power of Attorney Page 1 of 3 SPECIAL DURABLE POWER OF ATTORNEY FOR BANK ACCOUNT MATTERS STATE OF GEORGIA COUNTY OF ________________________ KNOW ALL MEN BY THESE PRESENTS: That I, ____________________________________ of ________________________ County, Georgia, being of sound mind and memory, do hereby make, constitute and appoint ____________________________________ as my true and lawful agent and attorney in fact (hereinafter sometimes called "my agent"), with full power and authority to act for me, individually, and in my name, place and stead, with reference to the transaction of any and all business related to or connected with my bank accounts at ____________________________________ Bank, ____________________________________ (Address), ____________________________________ (City), Georgia, ___________ (Zip Code) hereinafter “Bank”, including, but not limited to, the following: 1. Making deposits, transfers and withdrawals to or from any of my bank accounts at Bank. 2. Writing, making and endorsing checks, drafts and other instruments in connection with my bank accounts at Bank. 3.
Receiving any and all payments and disbursements, including, without limitation, any cash payments, money orders or securities in the form of stocks, bonds, certificates of deposit, loan certificates, negotiable instruments, cashier's checks, money orders, checks, drafts, bills of exchange, money orders, trust bonds, promissory notes (other than bearer promissory notes) in the (address) in (city), of or concerning which I do or may hereafter be entitled to any interest, dividend or other compensation, on account of my bank account at bank. 4. (name) and any of my officers, directors, employees, agents or employees, with each, as the case may be, and the (name of every stockholder) under s. 20-110, (address) or pursuant to this chapter or the laws of this state, shall have no pecuniary interest whatsoever in any such business other than as compensation for his services as agent and attorney in fact, and shall not have any other business interest in any of my bank accounts at bank. In the event my agent or attorney in fact fails to comply with the provisions of this section, the creditor, seller, assignee or other person in whose name the same forms part of this account shall have the right to rescind the representation without further liability upon request to the creditor, seller, assignee or other person in which interest or in which the item is listed. I further acknowledge, acknowledge and agree that: (a) when any payments to or on account of all or a portion s of my bank accounts at bank have already been accepted, the payments shall be considered as having been received, and my agent or attorney in fact shall be deemed to have obtained proper title thereto by delivery of the funds to the bank or to the person or bank, as the case may be. (b) when all or a portion of my bank accounts at bank have not been accepted, any such payments shall be considered as being paid, and my agent or attorney in fact shall be deemed to have obtained proper title thereto by delivery of the funds to the person or bank, as the case may be. I further acknowledge and agree that: (a) in the event of my retirement or my death or disability, my agent or attorney in fact has a lien against (address), or on behalf of my estate, for all.