GENERAL POWER OF ATTORNEY
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Effective Date: ________________________________________________________
Place: _________________________________________________________________

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1. Parties
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This document is made on ____________________ (____________________) by:

Principal
Individual
Full Legal Name: _______________________________________________________
SSN / ID: ______________________________________________________________
Doc Series: ____________________________________________________________
Address: _______________________________________________________________
         _______________________________________________________________

In favor of:

Agent / Attorney-in-Fact
Individual
Full Legal Name: _______________________________________________________
SSN / ID: ______________________________________________________________
Doc Series: ____________________________________________________________
Address: _______________________________________________________________
         _______________________________________________________________

2. SUBJECT-MATTER SCHEDULE & SPECIFICATIONS
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Specific Powers Granted: _______________________________________________
Expiration / Revocation Condition:
    ____________________________________________________________________
Sub-Delegation Permitted: ______________________________________________

3. EXECUTION & SIGNATURES
-------------------------

Principal

Signature: _____________________________________________________________

Full Legal Name: _______________________________________________________
Date: __________________________________________________________________