Fill and Sign the Probate and Family Court Request for Trial Pre Trial Assignment Form

SAMPLE POWER OF ATTORNEY I, ____________________________, the undersigned, do hereby grant to _________________________, (please print) (please print) of ____________________________________________________, as my attorney-in-fact, to receive on (mailing address) my behalf information from Government Private Data Files, and to receive on my behalf all claim forms pertaining to such information. If any payment of an approved claim is to be sent payable to parties other than the named owner, print the desired name and address below: This power of attorney will expire upon receipt of the unclaimed funds or nine months from the date of notarization of this document, whichever comes first. ____________________________________________ Name as it appears in Government Data Files (please print) ____________________________________________ Signature of Client ____________________________________________ Address of Client ____________________________________________ ____________________________________________ Social Security Number of Client State of _______________________________ County of _______________________________ The affiant being duly sworn affirms and says that he or she is the signer(s) of the foregoing power of attorney, and that he or she has read the foregoing power of attorney and understands its contents. Subscribed and sworn to before me the ____________ day of ________________________, of 20_____. _______________________________________ (Notary Public Signature) _______________________________________ (Commission Expiration Date)