Louisiana General Power of Attorney

LOUISIANA POWER OF ATTORNEY

I, [Sender.FirstName][Sender.LastName], appoint (Agent.FirstName) (Agent.LastName) at (Agent.StreetAddress) (Agent.State) (Agent.PostalCode) as my Agent to act for me in any lawful way with respect to the following initialed subjects:

In the event that my Agent named above is unavailable or unable to fulfill his or her duties, I name the following to serve as successor agents:

Successor Agent Name: (SuccessorAgent1.FirstName) (SuccessorAgent1.LastName)

Successor Agent Address: (SuccessorAgent1.StreetAddress) (SuccessorAgent1.State) (SuccessorAgent1.PostalCode)

Successor Agent#2 Name: (SuccessorAgent2.FirstName) (SuccessorAgent2.LastName)

Successor Agent#2 Address: (SuccessorAgent2.StreetAddress) (SuccessorAgent2.State) (SuccessorAgent2.PostalCode)

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1. Real Property

2. Tangible Personal Property Transactions;

3. Stock and Bond Transactions;

4. Commodity and Option Transactions;

5. Banking and Other Financial Institution Transactions;

6. Business Operating Transactions

7. Insurance and Annuity Transactions

8. Estate, trust, and other Beneficiary Transactions;

9. Claims and Litigation;

10. Personal and Family Maintenance;

11. Benefits from Social Security, Medicare, Medicaid or other Governmental Programs or Civil or Military Service

12. Retirement Plan Transactions;

13. Tax Matters;

14. ALL OF THE POWERS LISTED IN (A) THOUGH (O).

SPECIAL INSTRUCTIONS

(add special instructions to limit or expand the powers granted to your Agent)

ACKNOWLEDGMENT AND SIGNATURES

Principal Acknowledgement

I agree that any third party who receives a copy of this document may act under it. Revocation of the power of attorney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree to indemnify the third party for any claims that arise against the third party because of reliance on this power of attorney.

Signed on this (day) day of (month), (year).                    

By accepting or acting under the appointment, the Agent assumes the fiduciary and other legal responsibilities of an agent.

A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.

Witness Acknowledgement

I, [Witness#1.FirstName][Witness#1.LastName], the witness, sign my name to the foregoing Power of Attorney being first duly sworn, and do declare to the undersigned authority the principal signs and executes this instrument as the Principal’s Power of Attorney and that the Principal signs it willingly, or willingly directs another to sign for the Principal, and that I, in the presence and hearing of the Principal sign this Power of Attorney as witness to the Principal’s signing, and to the best of my knowledge the Principal is eighteen years of age or older, of sound mind, and under no constraint or undue influence.

For Witness #2:

I, [Witness#2.FirstName][Witness#2.LastName], the witness, sign my name to the foregoing Power of Attorney being first duly sworn, and do declare to the undersigned authority the principal signs and executes this instrument as the Principal’s Power of Attorney and that the Principal signs it willingly, or willingly directs another to sign for the Principal, and that I, in the presence and hearing of the Principal sign this Power of Attorney as witness to the Principal’s signing, and to the best of my knowledge the Principal is eighteen years of age or older, of sound mind, and under no constraint or undue influence.

Notary Acknowledgement

State of Louisiana

County of (Name)

On (date)  before me, [Notary.FirstName][Notary.LastName],  personally appeared [Principal.FirstName][Principal.LastName], who provided to me onthe basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the state of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.