General Power of Attorney

I, the undersigned

(Full legal names) ___________________________

(SS/Identity number) ___________________ residing at ____________________________________

hereby appoint and authorize

(Full legal names) ___________________________

(SS/Identity number) ___________________ residing at ____________________________________

as my Attorney-in-Fact (Agent) and with the power of attorney, delegation and substitution, to perform acts
on my behalf which I have the power and capacity to perform.

If my Agent is unable to act on my behalf by reason of absence or by reason of mental incapacity or

bankruptcy or unable or unwilling to serve for any other reason, I designate

(Full legal names) ___________________________

(SS/Identity number) ___________________ residing at ____________________________________

as substitute Agent with the same general power of attorney.

1. I hereby revoke any and all previous powers of attorney signed by me except for my Power of Attorney for
Health Care which shall remain in force.

2. This power of attorney shall become effective on the

_____ day of ________________________20____ and shall expire on the
____ day of ______________________20____ or at an earlier date if revoked by me in writing.

3. This document shall be construed and interpreted as a general power of attorney and my Agent shall have
full authority to act on my behalf in relation to all my property and affairs.

OR

3. This document shall be construed and interpreted as a general power of attorney and my Agent shall have
full authority to act on my behalf in relation to my property and affairs, save for the following conditions and
restrictions:

3.1. _____________________

3.2. _____________________

4. I furthermore grant my Agent the authority to:

4.1. Make gifts within gift tax limits except to himself / herself.

4.2. Execute, amend or revoke any trust agreement.

4.3. Exercise the right to make a disclaimer on my behalf.

5. I indemnify and hold harmless my Agent from any loss that results from an error in judgment that was
made in good faith, save for willful misconduct or the failure to act in good faith under the authority of this
power of attorney.

6. I authorize my Agent to indemnify any third party from any claims which may arise against the third party
because of reliance on this power of attorney.

7. My Agent shall provide accurate records of all transactions completed on my behalf and shall provide
accounting records within_____ days if I so request or if a request is made by any other authorized
representative acting on my behalf.
8. My Agent shall be entitled to reasonable compensation for his / her services at a rate as set out by law and
for reimbursement of all reasonable expenses incurred on my behalf in his / her duties as my Agent.

Executed this ______ day of __________________20 ____

at ______________________________________

Signature: ________________________________

in the presence of the undersigned witnesses:

Witness 1.

Name: ______________________

Address: _____________________________________________

Signature: ________________________

Witness 2.

Name: ______________________

Address: _____________________________________________

Signature: ________________________

Acknowledgement

This document was acknowledged before me on this

______day of ____________________20__
by ________________________(Principal's full legal names) who is personally known to me or who has
provided identification in the form of _________________.

Signature of Notary Public ______________________

Full legal names ______________________________

My commission expires ________________________

State of ________________________

County of ______________________