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Form preview Vehicle export power of attorn... LIMITED POWER OF ATTORNEY FOR EXPORT/IMPORT OF PERSONAL EFFECTS AND VEHICLES DATE Applies to POV Personal Effects Initial I hereby name and appoint Type or Print Name of to be my lawful attorney-in-fact to act on my behalf to conduct all transactions necessary with the U. S. Customs Service in the proper exportation or importation of the below stated vehicle which is described as Year Make Model Color Body Vehicle Identification Number VIN Title Number and to do all things necessary to ensure compliance with all requirements pursuant to section 192 of the Customs Regulations. S. Customs Service in the proper exportation or importation of the below stated vehicle which is described as Year Make Model Color Body Vehicle Identification Number VIN Title Number and to do all things necessary to ensure compliance with all requirements pursuant to section 192 of the Customs Regulations. Signature of Owner Owner s Name- Type or Print Signature of Co-Owner Co-Owner s Name - Type or Print Home Address of Owner City/State/Country Zip Code. S. Customs Service in the proper exportation or importation of the below stated vehicle which is described as Year Make Model Color Body Vehicle Identification Number VIN Title Number and to do all things necessary to ensure compliance with all requirements pursuant to section 192 of the Customs Regulations. Signature of Owner Owner s Name- Type or Print Signature of Co-Owner Co-Owner s Name - Type or Print Home Address of Owner City/State/Country Zip Code.
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.

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