BC POWER OF ATTORNEY SHORT FORM - 2017 ADE

Schedule
Form 1
(Section 9)
Power of Attorney
(For the appointment of one attorney)
This General Power of Attorney is given on ............................................... (Date)
by .............................. (Donor) of ............................................................. (Donor's Address)
I appoint the following person:
.......................................... (Name of Attorney) of ....................................... (Address of Attorney)
to be my attorney in accordance with the Power of Attorney Act and to do on my behalf anything that I can lawfully do by an attorney.
This power of attorney is subject to the following conditions and restrictions:
(Cross this line out if there are no conditions or restrictions.)
WITNESSED BY:
.................................................
(Signature of Witness)
.................................................       .................................................
(Print Name of Witness)                               (Donor)
.................................................
(Address of Witness)