SPECIAL POWER OF ATTORNEY
I, ______________________________________, of _________________, hereby appoint ____________________________, of ____________________,
as my attorney in fact to act in my capacity to do any and all of the
following: [Describe Specific Authority You Are Giving To Attorney-In-Fact]
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
_________________________________________________________
The rights, powers, and authority of my attorney in fact to exercise any
and all of the rights and powers herein granted shall commence and be in
full force and effect on __________, 20____, and shall remain in full force
and effect until __________, 20____, or unless specifically extended or
rescinded earlier by either party.
Dated: __________, 20____
Signed: ________________________________________
Printed Name: _________________________________
STATE OF ILLINOIS, COUNTY OF __________
Sworn to and subscribed before me on this ______ day of ___________, 20___.
__________________________ Seal:
__________________________, Notary Public
my commission expires: ______________
