DATED THIS _______________________ DAY OF ___________________________ 2023
[INSERT DONOR’S NAME]
TO
[INSERT DONEE’S NAME]
________________________________
LIMITED POWER OF ATTORNEY
________________________________
NOTE THAT THIS IS A POWER OF ATTORNEY TO DEAL WITH A SPECIFIC PROPERTY
DRAWN BY:
[INSERT DONOR’S NAME]
BY THIS LIMITED POWER OF ATTORNEY given this…………Day of…………………2023, I
[INSERT NAME] of ID Number [INSERT] and of Address [INSERT] in the State of [INSERT],
HEREBY APPOINT [INSERT NAME OF ATTORNEY] of ID Number [INSERT] and of Address
[INSERT] in the State of [INSERT] to be my Attorney [Insert description of the specific power, for
example: to manage my finances; to sign legal documents related to the sale of my property; to
make healthcare decisions on my behalf; to represent me in court, etc.] with authority to do all
the acts hereunder specified on my behalf in relation to the property known as [INSERT LEGAL
DESCRIPTION OF PROPERTY AND ADDRESS] (hereinafter the “Property”).
AUTHORITY
The ATTORNEY shall have the full power and authority to undertake and perform only the
following acts on my behalf:
1. The power to lease the property.
2. The power to mortgage the property.
3. To take all steps necessary to prevent nuisance.
4. To protect the property from waste, damage or misuse.
5. To institute or defend the property in any legal proceedings.
6. To ensure that any rents due or in arrears are promptly paid.
7. To warn off, prohibit and take any action against trespassers.
8. To make any payments in relation to his functions under this Power of Attorney.
9. To sign all necessary documents and take all necessary actions related to the property.
10. To enter into and where necessary enforce any contracts and agreements that bind the
property.
11. To manage and maintain the property, including contracting for repairs, paying taxes and
insurance premiums, and receiving rent.
12. To demand, collect and receive and take all necessary steps to recover all rents and
other sums owing to me in relation to the property.
The authority herein shall include such incidental acts as are reasonably required to carry out
and perform the specific authorities granted herein. My Attorney agrees to accept this
appointment subject to its terms, and agrees to act and perform in said fiduciary capacity
consistent with my best interest, as my attorney-in-fact.
REVOCATION
This Power of Attorney shall take effect on [INSERT EFFECTIVE DATE] and shall remain in
effect until [EXPIRATION DATE], unless revoked earlier by me and shall automatically be
revoked upon my death, provided any person relying on this Power of Attorney shall have full
rights to accept and reply upon the authority of my attorney-in-fact until in receipt of actual
notice of revocation.
Upon such revocation by me, all powers donated to my Attorney shall revert back to me.
DECLARATION
IT IS HEREBY DECLARED THAT, I [INSERT NAME] agree to ratify all that shall be done by
the Attorney or cause to be done by him/her in the execution of this Power of Attorney.
SIGNED by the said: }
[INSERT DONOR’S NAME] } …………………………
I, [INSERT DONEE’S NAME] hereby accept appointment as the Attorney on the above terms.
SIGNED by the said: }
[INSERT DONEE’S NAME] } ……………………………
On this _________ day of ___________________, 20_____, the above-named
______________________________________ personally appeared before me and
acknowledged the foregoing to be (his/her) free act and deed.
………………………………………….
Notary Public
Dated:
Seal
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