HomeMy WebLinkAbout02-12 Power of AttorneyCAG
Special Limited Power of Attorney
County of Frederick, Virginia
w Frederick Planning Web Site: www.co.frederick.va.us
11JA
Department of Planning & Development, County of Frederick, Virginia,
107 North Kent Street, Suite 202, Winchester, Virginia 22601
Phone 540-665-5651 Facsimile 540-665-6395
Know All Men By Those Present: That I (We)
(Name) � /J % .��/ems � �11kf4t
(Address)
the owner(s) of all those tracts or parcels of land ("Property") conveyed to me (us), by deed recorded in the
Cleric's Office of the Circuit Court of the County of Frederick, Virginia, by
Instrument No.
on Page
and is described as
Parcel: Lot: Block: . Section: Subdivision:
do hereby make, constitute and appoint:
(Name) 1�'"/f 5 ��' jam'
(Phone)
(Address) � %?!L%�4C✓�%Cri �f/�GtA0Ve��1�fC�Lt�I
X159.
%-7��5
To act as my true and lawful attorney-in-fact for and in my (our) name, place, and stead with full power and
authority I (we) would have if acting personally to file planning applications for my (our) above described
Property, including:
❑ Rezoning (including proffers)
® Conditional Use Permits
❑ Master Development Plan (Preliminary and Final)
❑ Subdivision
❑ Site Plan
My attorney-in-fact shall have the authority to offer proffered conditions and to make amendments to
previously approved proffered conditions except as follows:
This authorization shall expire one year from the day it is signed, or until it is otherwise rescinded or
modified.
In witness thereof, I (we) have hereto set my (our) hand and seal this f day of � .� , 204
Signature(s)
State of Virginia, Cify/County of
!�,e . To -wit:
1,, , a Notary Public in and for the jurisdiction
aforesaid, certify that the person(s) who signed to the foregoing instrument personally appeared before me
and has acknowledged the same before me in the jurisdiction aforesaid this day of , 200
My Commission Expires:
Notary Public