LIMITED POWER OF ATTORNEY

This standardized Limited Power of Attorney form is designed to grant another person (the “Agent”) specific and limited authority to act on your behalf.

It includes:

• Appointment of Agent (Attorney-in-Fact)
• Clearly defined powers granted (with checkboxes for specific actions)
• Limitations to protect the Principal’s interests
• Duration and termination terms
• Revocation instructions
• Optional witness signatures and notary acknowledgment

Format: Fillable PDF (print or complete digitally)

Use Cases: Authorizing limited financial, real estate, tax, healthcare, or legal actions

Notarization: Includes a notary section to enhance validity and acceptance

⚠️ Disclaimer:

This is a general Limited Power of Attorney form and may not meet all requirements in every jurisdiction. It grants only the powers specified by the Principal and does not replace legal counsel. Please consult a licensed attorney for advice on your specific situation. Utsey Notary Services LLC does not provide legal advice.

Instructions:

Download instantly after purchase, complete the form, and have it notarized by Utsey Notary Services or any licensed notary of your choice before submitting it to your insurance company.