Limited Power of Attorney

BE IT KNOWN, that I ______________, the undersigned, do hereby grant a limited power of attorney to ________________, as my attorney.

My attorney shall have full power and authority to undertake and perform the following on my behalf:

(Describe specific authority)

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 interests as he in his [or her] discretion deems advisable.

This power of attorney may be revoked by me at any time, provided any person relying on this power of attorney shall have full rights to accept the authority of my attorney until in receipt of actual notice of revocation.

Signed this _________ day of __________, 20 __.