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Power of attorney for bank acc... SPECIAL DURABLE POWER OF ATTORNEY FOR BANK ACCOUNT MATTERS STATE OF LOUISIANA PARISH OF KNOW ALL MEN BY THESE PRESENTS That I of County Louisiana 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 but not limited to the following Making deposits transfers and withdrawals to or from any of my bank accounts at Writing making and endorsing checks drafts and other instruments in connection with my bank accounts at Bank. Opening new checking savings money market certificates of deposit IRA s or other accounts in my name and maintaining same. Approving and authorizing automatic withdrawals from my accounts. Executing signature cards for accounts maintained or opened by my agent in my name. Performing any and all other matters relating to or in connection with my bank accounts at Bank. I direct that the above-related powers and authority of my said agent shall be so exercisable and effective regardless of the fact that I may be mentally or physically incapacitated or incapable of understanding or unable to express myself or act in my own behalf at the time of any action on my behalf by said agent. Such incapacity whether mental or physical that I may exhibit shall not in any way interfere with the authority of my agent herein to act fully on my behalf according to the terms hereof* In other words this Power of Attorney shall not be affected by the subsequent disability incompetence or incapacity of the principal* And I do hereby undertake to ratify and confirm all and singular the acts heretofore performed and to be hereinafter performed by my said agents acting in my name and on my behalf* Bank shall honor this Power of Attorney until and unless Bank receives written notice of revocation of same signed by me. Bank is hereby indemnified and shall be held harmless by the undersigned for any and all actions taken by my agent regarding my accounts at Bank regardless of whether within the intended scope of this Power of Attorney or not therefore Bank shall have no liability for the actions of my agent or for following the directions of my agent in connection with my IN WITNESS WHEREFORE I have executed this Special Power of Attorney on this the day of 20. PRINCIPAL Witness ATTESTATION The hereinafter named Witnesses each declare under penalty of perjury under the laws of the State of Louisiana that the principal is personally known to us that the principal signed and acknowledged this special power of attorney in our presence that the principal appears to be of sound mind and under no duress fraud or undue influence that we are not the person appointed as attorneyin-fact by this document and that we witnessed this power of attorney in the presence of the principal* We are not related to the principal by blood marriage or adoption and to the best of our knowledge are not entitled to any part of the estate of the principal upon the death of the principal under a will now existing or by operation of law.

Oklahoma durable power of atto... This General Durable Power of Attorney is a general, durable power of attorney which is effective IMMEDIATELY. You can use this form to appoint an attorney-in-fact (agent) to make decisions regarding

Filable durable healthcare pow... STATE OF ARIZONA DURABLE HEALTH CARE POWER OF ATTORNEY Instructions and Form GENERAL INSTRUCTIONS: Use this Durable Health Care Power of Attorney form if you want to select a person to make future

Mcfarland clinic health care p... Authorization to Release Protected Health Information I understand that if the person(s) and or organizations(s) listed below are not health care providers, health plans or health care clearinghouses,

Arizona dmv power of attorney... POWER OF ATTORNEY with Odometer Disclosure 48-7104 R07/05 www.azdot.gov Clear Year Make Body Style Vehicle Identification Number Attorney-In-Fact (individual or organization you wish to act for you

Iowa bar association form 2013... Your Signature Declarant/Principal Address Street City State and Zip Type or Print Your Name IMPORTANT NOTE THIS DOCUMENT MUST BE SIGNED OR ACKNOWLEDGED BEFORE A NOTARY PUBLIC OR TWO WITNESSES. SEE REVERSE FOR NOTARY OR WITNESS FORMS. IF YOU WANT TO EXECUTE EITHER A LIVING WILL DECLARATION OR A MEDICAL POWER OF ATTORNEY BUT NOT BOTH SEPARATE FORMS ARE AVAILABLE FROM THE IOWA STATE BAR ASSOCIATION. IF YOU HAVE QUESTIONS REGARDING THIS FORM OR NEED ASSISTANCE TO COMPLETE IT YOU SHOULD CONSULT AN ATTORNEY. THE IOWA STATE BAR ASSOCIATION Official Form No. 123 FOR THE LEGAL EFFECT OF THE USE OF THIS FORM CONSULT YOUR LAWYER DECLARATION RELATING TO LIFE-SUSTAINING PROCEDURES Living Will AND DURABLE POWER OF ATTORNEY FOR HEALTH CARE DECISIONS Medical Power of Attorney If I should have an incurable or irreversible condition that will result either in death within a relatively short period of time or a state of permanent unconsciousness from which to a reasonable degree of medical certainty there can be no recovery it is my desire that my life not be prolonged by the administration of life-sustaining procedures. The Iowa State Bar Association 2013 IOWADOCS NOTARY PUBLIC FORM STATE OF COUNTY OF ss This record was acknowledged before me this day of by Signature of Notary Public WITNESS FORM We the undersigned hereby state that we signed this document in the presence of each other and the Declarant/Principal and we witnessed the signing of the document by the Declarant/Principal or by another person acting on behalf of the Declarant/Principal at the direction of the Declarant/Principal that neither of us is appointed as attorney in fact by this document that neither of us are health care providers who are presently treating the Declarant/Principal or employees of such a health care provider. If I am unable to participate in my health care decisions I direct my attending physician to withhold or withdraw life-sustaining procedures that merely prolong the dying process and are not necessary to my comfort or freedom from pain* This declaration is subject to any specific instructions or statement of desires I have added in Additional Provisions below. II. POWER OF ATTORNEY FOR HEALTH CARE DECISIONS I born designate Type or Print Name of Agent Street Address City State Zip Code and Phone Number as my attorney in fact my agent and give to my agent the power to make health care decisions for me. This power exists only when I am unable in the judgment of my attending physician to make those health care decisions. The attorney in fact must act consistently with my desires as stated in this document or otherwise made known* Except as otherwise specified in this document this document gives my agent the power where otherwise consistent with the laws of the State of Iowa to consent to my physician not giving health care or stopping health care which is necessary to keep me alive. This document gives my agent power to make health care decisions on my behalf including to consent to refuse to consent or to withdraw consent to any care treatment service or procedure to maintain diagnose or treat a physical or mental condition* This power is subject to any statement of my desires and any limitations included in this document.

Missouri form 5086 2014 2019 MISSOURI DEPARTMENT OF REVENUE MOTOR VEHICLE BUREAU Form 5086 PART?A - POWER OF ATTORNEY TO DISCLOSE MILEAGE OR TRANSFER OWNERSHIP SECURE POWER OF ATTORNEY A Secure Power of Attorney may only be used

Wells fargo power of attorney... Choose one E stablish the Power of Attorney designation on all of my Wells Fargo Advantage Funds accounts nonretirement and retirement. Click here to clear form Power of Attorney POA Complete this form to designate an individual as attorney-in-fact for your Wells Fargo Advantage Funds account s. I agree this Power of Attorney is governed by applicable California law. I for myself and my heirs executors legal representatives and assigns hereby agree to indemnify and hold harmless Wells Fargo Funds Management LLC the transfer agent for Wells Fargo Advantage Funds and any and all affiliated or nonaffiliated third parties from and against any and all claims that may arise against such third party by reason of any action or inaction by such third party having relied on this Power of Attorney and to pay such third party promptly on demand for any and all losses arising out of any act by agent under this Power of Attorney. The Power of Attorney is important to you. If you do not understand the Power of Attorney or any provision of it you should obtain the assistance of an attorney or other qualified person. Account Owner s Agreement I understand that this Power of Attorney designation shall replace any previous Power of Attorney designation I have made for the Wells Fargo Advantage Funds account s indicated in section 1 of this form. I agree that any third party may act under this Power of Attorney whether durable or nondurable without further inquiry or investigation and regardless of the date of such authorization. I hereby ratify and confirm any and all transactions heretofore and hereafter made by the agent pursuant to this Power of Attorney for my account s. An attorney-in-fact cannot be designated on custodial estate or guardianship accounts. If you have questions call 1-800-222-8222 24 hours a day 7 days a week. P. O. Box 8266 Boston Massachusetts 02266 www. wellsfargo. com/advantagefunds A C C O U N T I N F O R M AT I O N P L E A S E P R I N T Name of account owner or trustee first middle initial last Social Security number Name of joint account owner or co-trustee first middle initial last Name of trust if applicable Trust accounts Enclose a copy of the title page and the section of the trust document that allows for the appointment of an agent. Fund and account number T Y P E O F P O W E R O F AT T O R N E Y A N D D E S I G N AT I O N O F AT T O R N E Y - I N - FA C T This Power of Attorney is choose one D urable Power of Attorney will continue even if you become incapacitated* N ondurable Power of Attorney will terminate at such time as we receive actual notice of your incapacitation* I Name of attorney-in-fact hereby appoint hereinafter referred to as agent to act for me as my agent and attorney-in-fact for the account s defined as the accounts designated in section 1 of this form* The account s may include retirement accounts such as an IRA Qualified Retirement Plan QRP and/or SEP IRA collectively referred to as retirement accounts. By having my signature notarized in section 3 of this form I authorize the agent to act for me and on my behalf in the same manner and with the same force and effect as if I were acting with respect to such transactions as set forth below and all things necessary or incidental thereto Inquire about buy acquire sell redeem exchange assign or otherwise transfer to dispose of mutual fund shares change my dividend and distribution options direct and receive disbursements regardless of the tax consequences of such a disbursement and exercise any and all investment powers available under my account s Continued on next page.

Ohio bmv 5736 form 2016 2019 THESE PENALTIES ARE IN ADDITION TO ANY FINES OR PENALTIES IMPOSED BY A COURT OF LAW. WARNING THESE LAWS DO NOT PREVENT THE POSSIBILITY THAT YOU MAY BE INVOLVED IN AN ACCIDENT WITH A PERSON WHO HAS NO INSURANCE OR OTHER FR COVERAGE. WHEN REQUIRED PROOF OF COVERAGE MAY BE SHOWN BY ANY OF THE FOLLOWING AN INSURANCE POLICY showing automobile liability insurance of at least 25 000 bodily injury per person 50 000 injury two or more persons and 25 000 property damage AN INSURANCE IDENTIFICATION CARD same coverage A SURETY BOND OF 30 000 issued by any authorized surety company or insurance company A BMV BOND SECURED BY REAL ESTATE having equity of at least 60 000 A BMV CERTIFICATE FOR MONEY OR GOVERNMENT BONDS in the amount of 30 000 on deposit with the Ohio Treasurer of State A BMV CERTIFICATE OF SELF-INSURANCE available only to companies or persons who own at least twenty-six motor vehicles. DETACH BOTTOM PORTION FOR YOUR RECORDS THIS COMPLETED FORM MUST BE ATTACHED TO THE BMV APPLICATION additional offenses Lose his or her license plates and vehicle registration Pay reinstatement fees of 100. DETACH BOTTOM PORTION FOR YOUR RECORDS THIS COMPLETED FORM MUST BE ATTACHED TO THE BMV APPLICATION additional offenses Lose his or her license plates and vehicle registration Pay reinstatement fees of 100. 00 for first offense 300. 00 for second offense 600. 00 for third and subsequent offenses Pay a 50. 00 penalty for any failure to surrender his or her driver license license plates or registration AND Be required to maintain special FR coverage High-risk insurance or equivalent on file with the Bureau of Motor Vehicles BMV for THREE or FIVE YEARS. For third or subsequent offenses the vehicle will be forfeited and sold and the person will not be permitted to register any motor vehicle in Ohio for FIVE YEARS. SUSPENSION INDEFINITELY until all damages have been satisfied. OHIO DEPARTMENT OF PUBLIC SAFETY BUREAU OF MOTOR VEHICLES POWER OF ATTORNEY FOR OHIO VEHICLE REGISTRATION TO BE COMPLETED BY THE OWNER OR PURCHASER OF VEHICLE S LISTED BELOW I of hereby Print Full Name of Vehicle Owner appoint Print Address of Vehicle Owner to make application in my stead for registration or transfer of registration for the following vehicle s PLATE NUMBER VEH. YEAR MAKE TYPE COLOR SERIAL NUMBER VEHICLE OWNER DATE OF VEHICLE OWNER OH DL / OH ID VEHICLE OWNER SSN IF NO OH BIRTH DL / OH ID FOR BMV USE ONLY / CLERK VERIFICATION OF VEHICLE OWNER LIST DOCUMENT W / SSN VEHICLE OWNER PRESENTED OH DL / OH ID / MATCH IF NO OH DL / OH ID PROOF OF SSN REQUIRED IN THE CASE OF A LEASE OR JOINT OWNERSHIP YOU WILL BE REQUIRED TO PROVIDE THE LESSEE / ADDITIONAL OWNER S OHIO DRIVER LICENSE NUMBER DL OHIO ID CARD NUMBER ID SOCIAL SECURITY NUMBER SSN TAX IDENTIFICATION NUMBER EIN / TIN. LESSEE / ADDITIONAL VEHICLE OWNER NAME SSN IF NO OH DL / ID IDENTIFICATION OF PERSON GRANTED AUTHORITY PGA PGA U*S* / CANADIAN DL / ID PGA SSN IF NO U*S* / CANADIAN DL / ID IS AVAILABLE CLERK S INITIALS I certify I have reviewed documents to verify DL / ID or SSN* U*S* / CANADIAN DL / ID PGA can present U*S* or Canadian DL / ID X SSN VIA ACCEPTABLE DOCUMENT I acknowledge that I we the owner s or lessees of leased vehicle now have insurance or other financial responsibility coverage covering this vehicle and I we will not operate or permit the operation of this vehicle without FR coverage and that the vehicle will not be used as a commercial vehicle unless so registered* I understand and acknowledge that making false statements on this document is illegal and may subject me to criminal penalties.

Power of attorney signature de... THIS LIMITED POWER OF ATTORNEY FOR SIGNATURE DELEGATION SHALL BE GOVERNED BY THE LAWS OF THE STATE OF OHIO WITHOUT REGARD FOR CONFLICTS OF LAWS AND PRINCIPLES AND IS INTENDED TO BE VALID IN ALL JURISDICTIONS OF THE UNITED STATES OF AMERICA. Choice of Law. THIS LIMITED POWER OF ATTORNEY FOR SIGNATURE DELEGATION IS EFFECTIVE ONLY FOR CLAIM REIMBURSEMENT APPLICATIONS COST PREAPPROVAL APPLICATIONS CERTIFICATION AFFIDAVITS AND DIRECT PAYMENT AUTHORIZA...

Nc secretary of state financia... NORTH CAROLINA HEALTH CARE POWER OF ATTORNEY NOTICE: This document gives the person you designate your health care agent broad powers to make health care decisions, including mental health treatment

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