Fill and Sign the Special Power Form

After Recording Return to: ) ) ) ) ) ) ) ) --------Above This Line Reserved For Official Use Only---------------- MILITARY SPECIAL POWER OF ATTORNEY THIS IS A MILITARY POWER OF ATTORNEY PREPARED AND EXECUTED PURSUANT TO TITLE 10, UNITED STATES CODE, SECTION 1044B, BY A PERSON AUTHORIZED TO RECEIVE LEGAL ASSISTANCE FROM THE MILITARY SERVICES. FEDERAL LAW EXEMPTS A MILITARY POWER OF ATTORNEY FROM ANY REQUIREMENT OF FORM, SUBSTANCE, FORMALITY OR RECORDING THAT IS PRESCRIBED FOR POWERS OF ATTORNEY BY THE LAWS OF ANY STATE, COMMONWEALTH, TERRITORY, DISTRICT, OR POSSESSION OF THE UNITED STATES. FEDERAL LAW SPECIFIES THAT A MILITARY POWER OF ATTORNEY SHALL BE GIVEN THE SAME LEGAL EFFECT AS A POWER OF ATTORNEY PREPARED AND EXECUTED IN ACCORDANCE WITH THE LAWS OF THE JURISDICTION WHERE IT IS PRESENTED. KNOW ALL PERSONS, that I, _____________________________________________, _________________________________, a legal resident of ____________________________, and presently deployed to ________________________________________________________, desiring to execute a SPECIAL POWER OF ATTORNEY, do hereby appoint _______________ ____________________________________________, who currently resides at _____________ ________________________________________________ my Attorney - in - Fact to act as follows, granting unto my said Attorney full power to: State Powers Given TERMINATION: Unless sooner revoked or terminated by me, this Special Power of Attorney shall become NULL and VOID from and after _____________________________________. Not withstanding my insertion of a specific expiration date herein, if on the above specified expiration date, I shall be or have been carried in a military status of “missing,” "missing-in- action" or "prisoner of war, " then this power of attorney shall automatically remain valid and in full effect until sixty (60) days after I have returned to United States Military control following termination of such status. This power of attorney shall not be affected by the disability of the principal . - 1 - IN WITNESS WHEREOF, I have hereunto set my hand this __________ day of ______________________. ____________________________________ GRANTOR’S SIGNATURE At ________________________________________, I, ________________________________, the undersigned noncommissioned officer, do hereby certify that on this _________ day of ______________________________________, before me personally appeared _____________________________________________, who signed and executed the foregoing instrument I do further certify that I am at the date of this certificate a noncommissioned officer of the grade, branch of service and organization stated below In the active service of the United States Armed Forces, that by statute no seal is required on this certificate and that same is executed in my capacity as ___________________________ at __________________________ _____________________________________________________________________________. ____________________________________ SIGNATURE AUTHORITY TO NOTARIZE GRANTED UNDER _____________________ (SEAL) STATE OF ___________________ ____________________ COUNTY This Instrument of writing was filed for record on the _______ day of ____________ A.D. at __________ o’clock ____.M. and duly recorded in Vol. __________ on page _____. ____________________________ County/Clerk By __________________________ Deputy - 2 -