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Form preview Indiana health powers attorney... HEALTH POWERS OF ATTORNEY FORM FOR INDIANA RESIDENTS I appoint as my agent attorney-in-fact to act for me in any lawful way with respect to the Health Care Powers that may include acting as my agent with respect to mental health and addictions treatment services as defined and described in the Annotated Indiana Code which is incorporated by reference herein Health care powers. Health Powers of Attorney Form Created 1/15/09 Page 1 of 1 CHECK ONE OF THE FOLLOWING BOXES This power of attorney shall terminate upon my disability incapacity or incompetence. incompetence. I understand that in accordance with Indiana Code 30-5-10-1 except as otherwise stated in this power of attorney form this executed power of attorney may be revoked only in writing wherein the written revocation statement identifies the power of attorney revoked and is signed by myself the principal. This power of attorney shall continue in full force and effect until I have executed and recorded in the Recorder s Office of the county of my domicile a written revocation hereof. Signed this day of. Incompetence. I understand that in accordance with Indiana Code 30-5-10-1 except as otherwise stated in this power of attorney form this executed power of attorney may be revoked only in writing wherein the written revocation statement identifies the power of attorney revoked and is signed by myself the principal. This power of attorney shall continue in full force and effect until I have executed and recorded in the Recorder s Office of the county of my domicile a written revocation hereof. Signed this day of. Your signature Your social security number State of. County of. On this day of before me personally appeared executed this health powers of attorney form. Notary Public Page 2 of 2. Indiana Code 30-5-5-16 Sec. 16. a This section does not prohibit an individual capable of consenting to the individual s own health care or to the health care of another from consenting to health care administered in good faith under the religious tenets and practices of the individual requiring health care. b Language conferring general authority with respect to health care powers means the principal authorizes the attorney in fact to do the following 1 Employ or contract with servants companions or health care providers to care for the principal. 2 If the attorney in fact is an individual consent to or refuse health care for the principal who is an individual in accordance with IC 16-36-4 and IC 16-36-1 by properly executing and attaching to the power of attorney a declaration or appointment or both. Indiana Code 30-5-5-16 Sec* 16. a This section does not prohibit an individual capable of consenting to the individual s own health care or to the health care of another from consenting to health care administered in good faith under the religious tenets and practices of the individual requiring health care. b Language conferring general authority with respect to health care powers means the principal authorizes the attorney in fact to do the following 1 Employ or contract with servants companions or health care providers to care for the principal* 2 If the attorney in fact is an individual consent to or refuse health care for the principal who is an individual in accordance with IC 16-36-4 and IC 16-36-1 by properly executing and attaching to the power of attorney a declaration or appointment or both.
Form preview Financial power of attorney vi... VIRGINIA GENERAL DURABLE POWER OF ATTORNEY THE POWERS YOU GRANT BELOW ARE EFFECTIVE EVEN IF YOU BECOME DISABLED OR INCOMPETENT NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING. THEY
Form preview How do i get medical power of... APPOINTMENT OF SHORT-TERM GUARDIAN FOR MINOR CHILD(REN) AND DURABLE HEALTHCARE POWER OF ATTORNEY I/We, and , constituting the sole or all of the custodial ? parent(s) or ? court-appointed guardian(s)
Form preview Georgia general power of attor... STATE OF GEORGIA ) COUNTY OF ) GENERAL POWER OF ATTORNEY I, , do hereby appoint my , , with full power of substitution (herein called 'my attorney-in-fact'), my true and lawful attorney-in-fact,
Form preview Power of attorney for use in o... 1010021-E 2011-09 HSBC Bank Canada POWER OF ATTORNEY (for use in Ontario) THIS POWER OF ATTORNEY FOR PROPERTY is given by (name of Grantor) of (address of Grantor) 1. Appointment: I hereby appoint
Form preview Power of attorney the price fu... Limited Power of Attorney & Disclosure Acknowledgement Limited to Purchases and Sales of Futures Contracts The Customer hereby authorized: Name: As its agent and attorney to buy, sell and trade
Form preview Sample limited power of attorn... RECORDING REQUESTED BY MAIL TO ADDRESS Limited Power of Attorney I, (AKA ) of (city), (state), appoint of (city), (state), as my attorney-in-fact to act on my behalf for the purpose(s) of: This power
Form preview Power of attorney sample in ur... GENERAL POWER OF ATTORNEY I, born on Print Form S/O, D/O Mr. and holder of Passport no. presently residing at and originally belonging to appoint Mr. S/O Mr. resident of as my attorney to act on my
Form preview Power of attorney form for veh... POWER OF ATTORNEY FOR Insurance Auto Auctions Buyer Services Two Westbrook Corporate Center, ste#500 Westchester, IL 60154 cservice iaai.com fax: (708) 492-7999 VEHICLE PICK-UP Please be advised that:
Form preview Limited power of attorney copa... LIMITED POWER OF ATTORNEY For Vehicles Purchased in the Following States Arkansas Arizona Georgia Hawaii Indiana Kentucky Louisiana Main Mississippi Montana North Carolina North Dakota Nebraska New Jersey Oklahoma Pennsylvania South Carolina South Dakota Washington West Virginia and Wyoming STATE OF COUNTY OF KNOW ALL MEN BY THESE PRESENTS that I Name of Owner/Director/Officer the undersigned having power on behalf of Company do hereby make constitute and appoint COPART INC. as Company s true and lawful attorney-in-fact and by name place and stead and on Company s behalf and for Company s use and benefit 1. To fill out complete and sign vehicle titles and any documents or forms that Copart Inc* deems necessary or helpful to transfer ownership to Company of any vehicles purchased by Company through Copart Inc* 2. The rights powers and authorities of said attorney-in-fact granted in this instrument shall commence and be in full force on // and such rights powers and authorities shall remain in full effect thereafter until Company gives notice in writing that such rights powers and authorities are terminated* Dated this day of 20 Company Name Owner/Director/Officer Name Title Sworn to before this day Notary Public Attorney Bar Roll or Notary ID My Commission Expires 4830-9200-7959 v* 1. as Company s true and lawful attorney-in-fact and by name place and stead and on Company s behalf and for Company s use and benefit 1. To fill out complete and sign vehicle titles and any documents or forms that Copart Inc* deems necessary or helpful to transfer ownership to Company of any vehicles purchased by Company through Copart Inc* 2. To fill out complete and sign vehicle titles and any documents or forms that Copart Inc* deems necessary or helpful to transfer ownership to Company of any vehicles purchased by Company through Copart Inc* 2. The rights powers and authorities of said attorney-in-fact granted in this instrument shall commence and be in full force on // and such rights powers and authorities shall remain in full effect thereafter until Company gives notice in writing that such rights powers and authorities are terminated* Dated this day of 20 Company Name Owner/Director/Officer Name Title Sworn to before this day Notary Public Attorney Bar Roll or Notary ID My Commission Expires 4830-9200-7959 v* 1. as Company s true and lawful attorney-in-fact and by name place and stead and on Company s behalf and for Company s use and benefit 1. To fill out complete and sign vehicle titles and any documents or forms that Copart Inc* deems necessary or helpful to transfer ownership to Company of any vehicles purchased by Company through Copart Inc* 2. The rights powers and authorities of said attorney-in-fact granted in this instrument shall commence and be in full force on // and such rights powers and authorities shall remain in full effect thereafter until Company gives notice in writing that such rights powers and authorities are terminated* Dated this day of 20 Company Name Owner/Director/Officer Name Title Sworn to before this day Notary Public Attorney Bar Roll or Notary ID My Commission Expires 4830-9200-7959 v* 1.
Form preview Ny 019 power of attorney statu... NY 019 - Power of Attorney, Statutory Short Form, Revised 1/l/1997-(with Affidavit of Effectiveness 1994 Fidelity National Title Insurance Company of New York) CONSULT YOUR LAWYER BEFORE SIGNING THIS
Form preview Utah 75 5 durable power of att... UTAH 75-5 DURABLE POWER OF ATTORNEY FORM I. NOTICE - This legal document grants you (Hereinafter referred to as the Principal ) the right to transfer unlimited financial powers to someone else (Hereinafter

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