HomeMy WebLinkAbout03-05 Power of AttorneyPR I - Z Special Limited Power of Attorney
County of Frederick, Virginia
Frederick Planning Web Site: www.co.frederick.va us
Department of Planning & Development, County of Frederick, Virginia,
107 North Kent Street, Winchester, Virginia 22601
Phone 540-665-5651 Facsimile 540-665-6395
Know All Men By Those Present: That I (We)
(Name)
(Phone)
Address
the owner(s) of all those tracts or parcels of land ("Property') conveyed to me (us), by deed recorded in the
Clerks 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)
(Phone)
(Address)
To act as my true and lawful attomey-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:
❑ Rezoningft
(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This authorization shall expire one year from the day it is signed, or until it is otherwise rescinded or modified..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 thereo..f, I (we) have hereto set my (our) hand and seal this '-1 day of
Signature(s)�
State of Virginia,-.City/Cour of =l1ly 6,&, ,u To -wit:
I' c'/ a Notary Public in and for the jurisdiction aforesaid,
certify airat thOperson(s) who signed to the foregoing instrument personally appeared before me and has
ackndviledged the same before
fore me, in the jurisdiction aforesaid this day of
My Conunission Expires:
N Pub�c