Limited Power of Attorney - Indiana

LIMITED POWER OF ATTORNEY — INDIANA

Before you use this: Complete the precise transaction, authorized acts, property, amount limit, and end date and time before signing. This form uses the notary execution route: the principal signs in the notary's presence. If the agent will present a recordable instrument, record this power of attorney first and put its recording reference on that instrument.

1. Principal and attorney in fact

I, [PRINCIPAL FULL LEGAL NAME], of [ADDRESS], appoint [ATTORNEY IN FACT FULL LEGAL NAME], of [ADDRESS], as my attorney in fact solely for the transaction described below.

2. Limited grant

Specific transaction and counterparty: [DESCRIBE]

Acts the attorney in fact may perform and documents the attorney in fact may sign: [LIST EACH ACT AND DOCUMENT]

Property, account, or asset involved: [IDENTIFY; FOR LAND, ATTACH LEGAL DESCRIPTION]

Maximum payment, receipt, or commitment: $[AMOUNT / NONE]

Additional conditions: [DESCRIBE / NONE]

My attorney in fact may communicate with the named counterparty and obtain records only as reasonably needed to perform the listed acts. A blank act or property description grants no authority. This instrument grants no general authority over my other property or affairs and incorporates no broad statutory category under Ind. Code § 30-5-5-1.

3. Powers withheld

My attorney in fact may not make gifts; change transfer-on-death or beneficiary arrangements; exercise powers I hold as trustee, personal representative, or agent for another person; delegate discretionary authority; create, amend, or revoke a trust; transfer my property to the attorney in fact for that person's own benefit; make health-care decisions; or execute or revoke a will. The specific grant above controls even if a listed transaction might otherwise fall within a broader statutory power.

4. Effect, durability, and end

This power takes effect on the date I sign it in compliance with Indiana law. It is not terminated by my later incapacity.

This power and the attorney in fact's authority end when the described transaction is complete and, in all events, at [DATE AND TIME, INCLUDING TIME ZONE]. It may end sooner upon my revocation or another event under Indiana law. No other power of attorney is revoked by this instrument unless identified here: [PRIOR INSTRUMENT TO REVOKE / NONE]. A revocation must identify the prior power and reach the attorney in fact or other person who must act on it; if the prior power was recorded, record the revocation with the prior recording reference. See Ind. Code § 30-5-10-1.

5. Duties and records

My attorney in fact must act within this grant, with due care for my benefit and in a fiduciary capacity. The attorney in fact must keep complete records of every transaction under this power for the period required by Ind. Code § 30-5-6-4(a).

6. Principal's signature

I sign this limited power of attorney in the notary public's presence on [__/__/____] at [CITY, STATE].

Principal's signature: ____________________________________

Printed name: [PRINCIPAL FULL LEGAL NAME]

7. Notarial certificate

State of Indiana, County of [COUNTY].

On [__/__/____], [PRINCIPAL FULL LEGAL NAME] personally appeared before me, was identified to my satisfaction, signed this instrument in my presence, and acknowledged that the instrument was signed for the purpose stated in it.

Notary public signature: ____________________________________

Printed name: [NAME] Title: Notary Public Commission expiration: [DATE]
Official seal (including the notary's commission number): [AFFIX NOTARY SEAL]

Indiana county of notary commission (nonresident Indiana notary: Indiana county of primary employment): [____________________]

8. Attorney in fact's receipt (optional)

I acknowledge receipt of this instrument and agree to act only within its stated limits.

Attorney in fact's signature: ____________________________________ Date: [__/__/____]

9. Recording instruction

If the attorney in fact will sign a deed, mortgage, or another document that must be recorded, record this authorizing power of attorney before presenting that document for recording. The document presented by the attorney in fact must identify the book and page or instrument number where this power is recorded. Ind. Code § 30-5-3-3 also requires the power itself to satisfy applicable recording requirements, including notary and preparation statements. For an Indiana-executed property instrument subject to Ind. Code § 36-2-11-15(b), complete the Social Security number redaction affirmation below. Check the county recorder's requirements for both completed instruments.

Instrument prepared by: [NAME AND ADDRESS OF PREPARER]

Social Security number redaction affirmation (when § 36-2-11-15(b) applies): I affirm, under the penalties for perjury, that I have taken reasonable care to redact each Social Security number in this document, unless required by law. [PREPARER NAME OR SIGNATURE]