Durable Power of Attorney

Effective Date: ___/___/_____

Name: ______

Address: ______

City: ______State: ______Zip Code: ______

Do hereby declare:

Name: ______

Address: ______

City: ______State: ______Zip Code: ______

As my attorney in fact (“Agent”) with the following powers to be exercised in my name and for my benefit:

To do anything that I may have a right or duty to do, now or in the future. To maintain, manage or transfer any of my real and personal property. This includes entry into safety deposit boxes and the authority to sign checks on all of my banking accounts and to transfer money this may also include any certificates of deposit. To apply for a certificate of title for any automobile or other motor vehicle and to represent a transfer that the title to the listed motor vehicle is free and clear from all liens except those that may be set forth in transfer of assignments. As it relates to business, to collect money, to transact business for me and to conduct business in which I may be engaged in and to fully carry out or amend any business agreement that I may be a party to.

This document is to be interpreted under the law of ______as a general power of attorney. Any statements of specific powers do not restrict the general powers as granted to my above listed Agent.

This Durable Power of Attorney will not be affected by my disability, however, may be terminated by my written revocation or by my death.

I hereby revoke any and all prior Durable Power of Attorney that I have executed.

Signature: ______Date: ___/___/_____

Witnessed by:

Signature: ______Date: ___/___/_____

Signature: ______Date: ___/___/_____ Notary Public Acknowledgement:

This affidavit was subscribed, sworn to and acknowledged before me this, the ______day of the month of

______, 2______.

Signature of Notary Public: ______

My Commission Expires: ___/___/_____