"State of Georgia

County of

STATUTORY FORM POWER OF ATTORNEY

IMPORTANT INFORMATION

This power of attorney authorizes another person (your agent) to make

decisions concerning your property for you (the principal). Your agent will be

able to make decisions and act with respect to your property (including your

money) whether or not you are able to act for yourself. The meaning of

authority over subjects listed on this form is explained in O.C.G.A. Chapter

6B of Title 10.

This power of attorney does not authorize the agent to make health care

decisions for you.

You should select someone you trust to serve as your agent. Unless you

specify otherwise in the Special Instructions, generally the agent's authority

will continue until you die or revoke the power of attorney or the agent

resigns or is unable to act for you.

Your agent is not entitled to any compensation unless you state otherwise

in the Special Instructions. Your agent shall be entitled to reimbursement of

reasonable expenses incurred in performing the acts required by you in your

power of attorney.

This form provides for designation of one agent. If you wish to name more

than one agent, you may name a successor agent or name a coagent in the

Special Instructions. Coagents will not be required to act together unless you

include that requirement in the Special Instructions.

If your agent is unable or unwilling to act for you, your power of attorney

will end unless you have named a successor agent. You may also name a second

successor agent.

This power of attorney shall be durable unless you state otherwise in the

Special Instructions.

This power of attorney becomes effective immediately unless you state

otherwise in the Special Instructions.

If you have questions about the power of attorney or the authority you are

granting to your agent, you should seek legal advice before signing this form.

DESIGNATION OF AGENT

I (Name of principal) name the following person as my agent:

Agent's address:

Agent's telephone number:

Agent's e-mail address:

DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)

If my agent is unable or unwilling to act for me, I name as my successor

Successor agent's address:

Successor agent's telephone number:

Successor agent's e-mail address:

If my successor agent is unable or unwilling to act for me, I name as my

Second successor agent's address:

Second successor agent's telephone number:

Second successor agent's e-mail address:

GRANT OF GENERAL AUTHORITY

I grant my agent and any successor agent general authority to act for me

with respect to the following subjects as defined in O.C.G.A. Chapter 6B of

Title 10:

If you wish to grant general authority over all of the subjects, you may

initial 'all preceding subjects' instead of initialing each subject.)

( ) Real property

( ) Tangible personal property

( ) Stocks and bonds

( ) Commodities and options

( ) Banks and other financial institutions

( ) Operation of entity or business

( ) Insurance and annuities

( ) Estates, trusts, and other beneficial interests

( ) Claims and litigation

( ) Personal and family maintenance

( ) Benefits from governmental programs or civil or military service

( ) Retirement plans

( ) Taxes

( ) All preceding subjects

GRANT OF SPECIFIC AUTHORITY (OPTIONAL)

My agent SHALL NOT do any of the following specific acts for me UNLESS I

have INITIALED the specific authority listed below:

to take actions that could significantly reduce your property or change how

your property is distributed at your death. INITIAL ONLY the specific

authority you WANT to give your agent. You should give your agent specific

instructions in the Special Instructions when you authorize your agent to make

gifts.)

( ) Create, fund, amend, revoke, or terminate an inter vivos trust

( ) Make a gift, subject to the limitations of O.C.G.A. § 10-6B-56 and any

Special Instructions in this power of attorney

( ) Create or change rights of survivorship

( ) Create or change a beneficiary designation

( ) Authorize another person to exercise the authority granted under this

power of attorney

( ) Waive the principal's right to be a beneficiary of a joint and

survivor annuity, including a survivor benefit under a retirement plan

( ) Exercise authority over the content of electronic communications sent

or received by the principal

( ) Exercise fiduciary powers that the principal has authority to delegate

and that are expressly and clearly identified (including the persons for which

the principal acts as a fiduciary) in the Special Instructions

( ) Renounce an interest in property, including a power of appointment

LIMITATION ON AGENT'S AUTHORITY

An agent that is not my ancestor, spouse, or descendant SHALL NOT use my

property to benefit the agent or a person to whom the agent owes an obligation

of support unless I have included that authority in the Special Instructions.

SPECIAL INSTRUCTIONS (OPTIONAL)

You may give special instructions on the following lines (you may add lines

or place your special instructions in a separate document and attach it to the

EFFECTIVE DATE

This power of attorney is effective immediately unless I have stated

otherwise in the Special Instructions.

NOMINATION OF CONSERVATOR (OPTIONAL)

If it becomes necessary for a court to appoint a conservator of my estate,

Nominee's address:

Nominee's telephone number:

Nominee's e-mail address:

RELIANCE ON THIS POWER OF ATTORNEY

Any person, including my agent, may rely upon the validity of this power of

attorney or a copy of it unless that person has actual knowledge it has

terminated or is invalid.

SIGNATURE AND ACKNOWLEDGMENT

Your signature Date

Your name printed

Your address

Your telephone number

Your e-mail address

This document was signed or acknowledged in my presence on

, by .

(Date) (Name of principal)

.

(Witness's signature)

.

(Witness's name printed)

Witness's address

Witness's telephone number

Witness's e-mail address

State of Georgia

County of

This document was signed or acknowledged in my presence on

, by .

(Date) (Name of principal)

(Seal)

Signature of notary

My commission expires:

This document prepared by: .

IMPORTANT INFORMATION FOR AGENT

Agent's Duties

When you accept the authority granted under this power of attorney, a

special legal relationship is created between you and the principal. This

relationship imposes upon you legal duties that continue until you resign or

(1) Do what you know the principal reasonably expects you to do with the

principal's property or, if you do not know the principal's expectations, act

in the principal's best interest;

(2) Act in good faith;

(3) Do nothing beyond the authority granted in this power of attorney;

and

(4) Disclose your identity as an agent whenever you act for the

own name as "agent" in the following manner:

Unless the Special Instructions in this power of attorney state otherwise,

(1) Act loyally for the principal's benefit;

(2) Avoid conflicts that would impair your ability to act in the

principal's best interest;

(3) Act with care, competence, and diligence;

(4) Keep a record of all receipts, disbursements, and transactions made

on behalf of the principal;

(5) Cooperate with any person that has authority to make health care

decisions for the principal to do what you know the principal reasonably

expects or, if you do not know the principal's expectations, to act in the

principal's best interest; and

(6) Attempt to preserve the principal's estate plan if you know the plan

Termination of Agent's Authority

You must stop acting on behalf of the principal if you learn of any event

that terminates this power of attorney or your authority under this power of

attorney. Events that terminate a power of attorney or your authority to act

under a power of attorney include:

(1) Death of the principal;

(2) The principal's revocation of your authority or the power of

attorney;

(3) The occurrence of a termination event stated in the power of

attorney;

(4) The purpose of the power of attorney is fully accomplished; or

(5) If you are married to the principal, a legal action is filed with a

Instructions in this power of attorney state that such an action will not

terminate your authority.

Liability of Agent

The meaning of the authority granted to you is defined in O.C.G.A. Chapter

6B of Title 10. If you violate O.C.G.A. Chapter 6B of Title 10 or act outside

the authority granted, you may be liable for any damages caused by your

violation.

If there is anything about this document or your duties that you do not

understand, you should seek legal advice."