MINNESOTA STATUTORY SHORT FORM POWER OF ATTORNEY

MINNESOTA STATUTES, SECTION 523.23

IMPORTANT NOTICE:  The powers granted by this document are broad and sweeping.  They are defined in Minnesota Statutes, section 523.24.  If you have any questions about these powers, obtain competent advice.  This power of attorney may be revoked by you if you wish to do so.  This power of attorney is automatically terminated if it is to your spouse and proceedings are commenced for dissolution, legal separation, or annulment of your marriage.  This power of attorney authorizes, but does not require, the attorney-in-fact to act for you.

PRINCIPAL (Name and Address of Person Granting the Power)

____________________________________________________

____________________________________________________

____________________________________________________

ATTORNEYS(S)-IN-FACT                                   SUCCESSOR ATTORNEY(S)-IN-FACT

(Name and Address)                                          (Optional) To act if any named attorney-in-fact

dies, resigns, or is otherwise unable to serve.

(Name and Address)

__________________________________             First Successor _____________________

__________________________________             __________________________________

__________________________________             __________________________________

__________________________________             Second Successor___________________

__________________________________             __________________________________

__________________________________             __________________________________

NOTICE:  If more than one attorney-in-fact is designated, make a check or "x" on the line in front of one of the following statements:

____     Each attorney-in-fact may                       EXPIRATION DATE (Optional)

independently exercise                           _______________________, _________

the powers granted.                                Use Specific Month Day Year Only

____     All attorneys-in-fact must jointly

exercise the powers granted.

I, (the above-named Principal) hereby appoint the above named Attorney(s)-in-Fact to act as my attorney(s)-in-fact:

FIRST:  To act for me in any way that I could act with respect to the following matters, as each of them is defined in Minnesota Statutes, section 523.24:

(To grant to the attorney-in-fact any of the following powers, make a check or "x" on the line in front of each power being granted.  You may, but need not, cross out each power not granted. Failure to make a check or "x" on the line in front of the power will have the effect of deleting the power unless the line in front of the power of (N) is checked or x-ed.)

Check or "x"

____     (A) real property transactions; I choose to limit this power to real property in ____________________ County, Minnesota, described as follows:

(Use legal description.  Do not use street address.)

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

(If more space is needed, continue on the back or on an attachment.)

____     (B) tangible personal property transactions;

____     (C) bond, share, and commodity transactions;

____     (D) banking transactions;

____     (E) business operating transactions;

____     (F) insurance transactions;

____     (G) beneficiary transactions;

____     (H) gift transactions;

____     (I) fiduciary transactions;

____     (J) claims and litigation;

____     (K) family maintenance;

____     (L) benefits from military service;

____     (M) records, reports, and statements;

____     (N) all of the powers listed in (A) through (M) above and all other matters.

SECOND:  (You must indicate below whether or not this power of attorney will be effective if you become incapacitated or incompetent.  Make a check or "x" on the line in front of the statement that expresses your intent.)

____     This power of attorney shall continue to be effective if I become incapacitated or incompetent.

____     This power of attorney shall not be effective if I become incapacitated or incompetent.

THIRD:  (You must indicate below whether or not this power of attorney authorizes the attorney-in-fact to transfer your property to the attorney-in-fact.  Make a check or "x" on the line in front of the statement that expresses your intent.)

____     This power of attorney authorizes the attorney-in-fact to transfer my property to the attorney-in-fact.

____     This power of attorney does not authorize the attorney-in-fact to transfer my property to the attorney-in-fact.

FOURTH:  (You may indicate below whether or not the attorney-in-fact is required to make an accounting.  Make a check or "x" on the line in front of the statement that expresses your intent.)

____     My attorney-in-fact need not render an accounting unless I request it or the accounting is otherwise required by Minnesota Statutes, section 523.21.

____     My attorney-in-fact must render____________________ (Monthly, Quarterly, Annual) accountings to me or _____________________________________________________
_____________________________________________________ (Name and Address) during my lifetime, and a final accounting to the personal representative of my estate, if any is appointed, after my death.

In Witness Whereof I have hereunto signed my name this ______ day of _________________, _________.

__________________________________

(Signature of Principal)

(Acknowledgment of Principal)

STATE OF MINNESOTA           )

) ss.

COUNTY OF                            )

The foregoing instrument was acknowledged before me this ______ day of _________________, _________, by __________________________________ (Insert Name of Principal).

__________________________________

(Signature of Notary Public or other Official)

This instrument was                                           Specimen Signature of

drafted by:                                                         Attorney(s)-in-Fact

(Notarization not required)

__________________________________             __________________________________

__________________________________             __________________________________

__________________________________             __________________________________

__________________________________             __________________________________

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