Specific Power Of Attorney

Please fill out this form and submit it to our office. Please notice at the end of the form, is our RELEASE OF LIABILITY. Please carefully read it and type in your name and the date at the end before you submit our form. If you wish to have a printable form, it will be at the bottom. Please call our office to verify that we have received your form.

Specific Power Of Attorney

Person Giving Authority

Name of person giving authority *
Best Contact Phone Number: *
Your Contact Email Address: *
Date Of Birth: *
Full Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Person receiving authority:

Name / Person Receiving Authority *
Relationship To Name Listed As Giving Authority *
Date Of Birth: *
Full Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Alternate Person / Receiver

Name Of Alternate Person/Receiver
Relationship To Name Listed As Giving Authority
Date Of Birth
Full Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Intent Of Power Of Attorney

Reason: *
Provide needed information: (child(ren)’s name(s) and dob, Deed OR other Information)
Please provide a copy of your current deed or document to help with the successful completion of your form.
Checkbox *
Please read the information below and by clicking on EACH CHECK BOX below acts as you read and agree to the terms below. I have been informed by the Staff of Express L C L Services, Inc. d/b/a Express Non Lawyer that:They ARE NOT ATTORNEYS, & they CANNOT GIVE LEGAL ADVICE.They are only assisting me in the proper preparation of these documents so that I can represent myself in this matter without an attorney.They have further informed me that legal representation by an attorney would advise me of all legal rights that I may have arising out of this action.The legal documents prepared by Express L C L Services, Inc. d/b/a Express Non Lawyer,have been prepared in accordance with the information provided by me in my desire to represent myself in this transaction.I declare:That the information provided by me is true and complete to the best of my knowledge and belief;That I agree to review all documents prepared and my signature is acknowledgment of my approval of all documents;That I hereby release Express L C L Services, Inc. d/b/a Express Non Lawyer, from any liability arising out of the services performed for me by them as the result of my failure to provide the information requested or to thoroughly review all documents. I further declare that I am signing this document without undue influence, threat or pressure from any person or entity involved in the outcome of this transaction.I understand that any and all payments made to Express L C L Services, Inc. d/b/a Express Non Lawyer, for the preparation of any documents are non-refundable and that I have been informed that I must pick up my documents within 90 days of completion or the documents maybe destroyed and/or I may incur additional fees as determined applicable by the Staff of Express L C L Services, Inc. d/b/a Express Non Lawyer.
By Entering The Date & Name below, I hereby agree to the terms listed in the RELEASE OF LIABILITY. *
First & Last Name *
Today's Date *

Are You A Human?

Please enter these two digits *Example: 20
This box is for spam protection - please leave it blank:

Specific Power Of Attorney

Express NonLawyer

Phone:

(321) 729-6399

Address:

Email Us:

Business Hours:

Please note:

Specific Power Of Attorney

Specific Power Of Attorney

Person Giving Authority

Person receiving authority:

Alternate Person / Receiver

Intent Of Power Of Attorney

Are You A Human?