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. _________________________

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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 wilful 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 _________________________

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