Laserfiche WebLink
<br />.. Statutory Durable Power of Attorney Form <br /> <br />. <br /> <br />Page 3 of3 <br /> <br />0.1 ()6'087 <br /> <br />another person for purposes of this power of attorney, A third party who accepts this power of attorney <br />is fully protected from any action taken under this power of attorney that is based on the determination <br />made by a physician of my disability or incapacity. <br /> <br />I agree that any third party who receives a copy of this document may act under it. Revocation of the <br />durable power of attorney is not effective as to a third party until the third party receives actual notice of <br />the revocation. I agree to indemnify the third party for any claims that arise against the third party <br />because of reliance on this power of attorney. <br /> <br />If any agent named by me dies, becomes legally disabled, resigns, or refuses to act, I name the following <br />(each to act alone and successively, in the order named) as successor(s) to that agent: <br />B:tl 'BlA.~d.. <br /> <br />Signed this ~ day of 5 erk.-.,,*Y"", ~. ;;2.. t7't> I <br /> <br />State of ~1If/(i vt~){.{r; <br /> <br />- r-- <br />County of <- <br /> <br />~-??J~~ <br />/ 0 (your signature) <br /> <br />This <br /> <br /> <br />ent,was ackI)owledged before me on <br />v (name ofprinci al). <br /> <br /> <br />'\C0 [(date) by <br /> <br />(Seal, if any, of notary) <br /> <br />{;-7ruf M. ('tv\Z" Mil TON' - Hi..., J)..)iV0c.; ('/1 <br />(printed name) <br /> <br />/, <br /> <br />My commission expires: Jja, "tJ, 01, ju)~ <br /> <br />THE AITORNEY IN FACT OR AGENT, BY ACCEPTING OR ACTING UNDER THE <br />APPOINTMENT, ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES OF AN <br />AGENT. <br /> <br />~e-\v\1("y\ 10', ~.; -\c\ <br />1.0 I 0 ~ ,4h <br /> <br />PC-YiS, f..,... <br /> <br />~ r~IVo\ <br /> <br />5-\,. SE <br />'I S-LtL,~p 111 G ilAlif 0163 <br /> <br />http://www.texasprobate.com/forms/poa.htrn <br /> <br />9/17/2001 <br /> <br />-r- <br />