(REPLACE ALL THE RED TEXT WITH YOUR INFORMATION)

Download and edit this sample document.

SPECIAL POWER OF ATTORNEY

This limited and Special Power of attorney is given on:   June 28th, 2010

    by:   Betty Ann Edwards

    of:  344 John Street, Toronto, Ontario, M3J1K4 .

I appoint:  Donald Raymond Miller

    of:   11 Parkview Blvd., Hamilton, Ontario, L8P4V0  to be my attorney.

Said attorney-in-fact shall have full power and authority to undertake and perform only the following acts on my behalf:

  • Pay my Bell Canada telephone bill each month, to Bell Canada Inc., up to a maximum of $100 per month, to be paid by the 15th of each month, from my Royal Bank Account: #0027-41134.
  • Pay my Roger's cable bill each month, to Roger's Inc., up to a maximum of $125 per month, to be paid by the 10th of each month, from my Royal Bank Account: #0027-41134.

The authority herein shall include such incidental acts as are reasonably required to carry out and perform the specific authorities granted herein.

This power of attorney is subject to the following conditions or restrictions:

  • The authority granted under this power of attorney ends if I become mentally incompetent.
  • No other restrictions.

The rights, powers, and authority herein granted shall be in full force and effect:

    Until: July 28th, 2013.

Date:
                                .

Signature of Donor:
                                                      

Printed Name of Donor:
Betty Ann Edwards             

Witnessed:

Date:
                                .

                                                  

Notary Public in and for Ontario
Toronto-Notary-Public.com

Disclaimer

Nothing on this site shall be considered legal advice and no attorney-client relationship is established.