DURABLE POWER OF ATTORNEY

The Durable Power of Attorney is made and effective _____________, 20___

BETWEEN:

_____________________________________ with an address of

_______________________________

_____________________________________ hereinafter referred to as the "Principal"

AND:

_____________________________________ with an address of

_______________________________

_____________________________________ hereinafter referred to as the "Agent"

1. APPOINTMENT OF AGENT:

I, the undersigned Principal, being of sound mind and fully capable of making decisions,
hereby designate and appoint the above-named Agent as my true and lawful attorney-in-fact
with full power and authority to make decisions and manage my affairs without limitation.
They are authorized to represent my interests and actions that I would otherwise be capable
of taking related to the following matters. (Initial only those powers you want to grant.)

2. POWERS OF ATTORNEY-IN-FACT:

By executing this Power of Attorney and initialing the boxes provided, I authorize the Agent
to:

(Indicate the relevant power(s) by placing your initials in the provided space.)

_____ (A) BANKING: To receive and deposit funds in any financial institution, and write
checks or drafts against such funds; to withdraw funds; to enter safe deposit boxes; to sell,
assign, convey, and deliver any securities and other elements of business transactions for
financial gains for all banking matters that require action and representation by the Agent,
and to sign any document required by the banking institution.

_____ (B) GOVERNMENT BENEFITS: To apply for and receive any government benefits to
which I may be entitled or become eligible, including but not limited to, Social Security,
Medicare, and Medicaid.

_____ (C) LENDING OR BORROWING: To extend loans in my name, to borrow funds for
my obligations, to sell, assign, and/or pledge any of all of the securities, real estate, personal
property, or other assets regardless of their nature or location, held by me directly or
indirectly, to extend, renew, modify, or refinance any debt or liability.

_____ (D) SAFE DEPOSIT BOX: I authorize my attorney-in-fact to have access at any time
or times to any safe-deposit box rented by me or to which I may have access, wheresoever
located, including drilling or forcing the box in the event the key or combination is
unavailable, and to remove all or any part of the contents thereof, and to surrender or
relinquish said safe-deposit box. Any institution in which any such safe-deposit box may be
located shall not incur any liability to me or my estate as a result of permitting my
attorney-in-fact to exercise this power.

_____ (E) TAXES: To prepare, complete, and sign any local, state, and federal tax returns
on my behalf; to pay property tax levies and assessments due; to receive refunds and other
benefits related to tax filings; to act as my representative with the IRS from these powers.

_____ (F) RETIREMENT PLAN: If permitted to do so, select a payment option of roll over,
receive benefits under any retirement plan or IRA I now own, withdraw from, or shall not
have power to change the beneficiary of any of my retirement plans or accounts.

_____ (G) REAL ESTATE: To acquire, purchase, exchange, lease, rent, sell, and convey
real property or any interests therein, on terms and conditions, including option
arrangements, identical to the property transaction as my agent shall deem suitable for such
purposes. To sign the relevant documents necessary or in connection therewith.

_____ (H) POWER TO MANAGE PROPERTY: To maintain, repair, improve, invest,

manage, insure, rent, lease, encumber, and in any manner deal with any real or personal
property, tangible or intangible, or any interest therein, that I now own or may hereafter
acquire, in my name and for my benefit, upon such terms and conditions as my Agent shall
deem proper.

_____ (I) INSURANCE: To purchase, pay premiums, and make claims on life, health,
accident, disability, and homeowners insurance on my behalf. My agent shall have the power
to cash in or change the beneficiary of any life insurance policy.

_____ (J) PERSONAL PROPERTY: To acquire, purchase, exchange, lease or rent, sell,
convey, release, or otherwise dispose of any type of personal property, goods, chattels,
rights, and credits, under such terms and conditions, including credit arrangements, as my
attorney in fact deems proper. To maintain, repair, improve, manage, preserve, and insure
such property, to establish and utilize bank accounts and other arrangements for financial
matters.

_____ (K) CLAIMS AND LITIGATION: I authorize the demanding, suing for, collecting,
recovering, and receiving of all claims or sums of money that are now or shall hereafter
become due, owing, or payable to me, and to institute and prosecute proceedings to recover
debts, buildings, settlements, or other structures that I may be entitled to receive.
Furthermore, I grant the authority to settle, accept, and reject any claims that may be
asserted against me.

_____ (L) HIRING SERVICE PROVIDERS: To hire service providers such as attorneys,
accountants, and others, including their compensation arrangements, as deemed suitable for
my purposes.

_____ (M) PERSONAL AND FAMILY MAINTENANCE: To make payments for the living
expenses, supplies, medical care, and comfort of my household.

SPECIAL INSTRUCTIONS: On the following lines are any special instructions relating or
limiting the powers I grant to my attorney-in-fact (Write "None" if no additional instructions
are needed):

_________________________________________________________________________

_________________________________________________________________________

3. LIABILITY OF ATTORNEY-IN-FACT:

My attorney-in-fact shall not be liable to me under this power, except for a breach of fiduciary
duty.

4. AUTHORITY OF ATTORNEY-IN-FACT:

Any party dealing with my attorney-in-fact hereunder may rely absolutely on the authority
granted herein and need not look to the application of any proceeds nor the authority of my
attorney-in-fact regarding any action taken hereunder. In this regard, no person who may act
in good faith will to reliance upon the representations of my attorney-in-fact or the authority
granted hereunder shall incur any liability to me or my estate as a result of such reliance,
and I, for myself and for my heirs, executors, legal representatives, and assigns, hereby
ratify and confirm whatever my Agent will do or cause to be done by virtue of this document.
By delivery of this instrument, the attorney-in-fact accepts the appointment. I hereby declare
that this instrument shall be given full judicial effect.

5. REIMBURSEMENT AND COMPENSATION:

My attorney-in-fact shall be entitled to reimbursement for reasonable expenses incurred in

exercising powers hereunder and to reasonable compensation for services provided under
this power.

6. AMENDMENT AND REVOCATION:

I reserve the right to revoke or amend this power of attorney through a written document
signed by me. Such amendment or revocation shall become effective upon delivery to my
attorney-in-fact. However, it is expressly acknowledged that third parties who have relied
upon this power shall have the right until the third party has received notice of such
revocation or amendment.

7. PHOTOCOPIES:

All photocopies of this Agreement shall have the same force and effect as any original.

8. STATE LAW:

This Power of Attorney is governed by the laws of the State of _______________.

IN WITNESS WHEREOF, I have, on this ________ day of _________, 20___, executed this
Durable Power of Attorney.

___________________________

Principal's Signature

On this ________ day of _________, 20___, before me appeared

___________________________, Principal of this Power of Attorney who proved to me
through government-issued identification to be the person named herein who signed the
executed foregoing instrument and acknowledged that (s)he executed the same as his/her
free act and deed.

___________________________

Notary Public

My commission expires: _______, 20___

SPECIMEN SIGNATURE AND ACCEPTANCE OF APPOINTMENT

I, ________________________, the attorney-in-fact named above, hereby accept

appointment as attorney-in-fact in accordance with the foregoing instrument.

___________________________

Attorney-in-Fact's Signature

STATE OF _______________
COUNTY OF _______________

On this ________ day of _________, 20___, before me, ________________________, as

Attorney in Fact in this Power of Attorney who proved to me through government-issued
photo identification to be the above-named person, being duly sworn, did execute the
foregoing acceptance of appointment, and did the same as his/her free act and deed.

___________________________

Notary Public

My commission expires: _______, 20___

*The foregoing document affirms in the presence of the principal that the principal has
signed and executed this document before both of us. The principal willingly signed in our
presence. The principal appears to be of sound mind and under no duress, fraud, or undue
influence. We, at the principal's request and in the principal's and, in each other's presence,
have signed below as witnesses and are not related to the principal, and are not entitled to
any portion of the estate of the principal under any existing will or codicil thereto.*

___________________________

1st Witness Signature

___________________________

Address

___________________________

2nd Witness Signature

___________________________

Address