I, ____________________________ (Principal) being of sound mind and judgment do hereby authorize, ___________________________ (Agent)on this the ________day, in the month of____________________ and the year of___________, to stand on my behalf, as my Attorney in Fact (Agent), and hereby grant the full authority to the person named herein, the ability to facilitate the following duties: to act as Attorney in Fact (Agent) to obtain all necessary government documents & paperwork relating to the case of

______________________________; to consult with or hire legal counsel in pursuance thereof, or as necessary for purposes of legal representation in defense of the Principal’s court case; and to utilize all powers reasonably implied in furtherance of the described duties. The individual listed herein shall have full said authority as described, beginning on the date indicated on this document and shall continue unless otherwise made null and void by me, to perform all applicable and necessary actions to facilitate the specific duties as described herein.

______________________________________________ ____/____/____

Signature of Authorizing Party Date

Printed name of authorizing Party; _________________________________

______________________________________________ ____/____/___

Signature of Notary Date

Notary Seal: __________________________