HomeMy WebLinkAbout06-20 Power of AttorneyCOGS Special Limited Power of Attorney
o County of Frederick, Virginia
� Frederick Planning Website: www.fcda.us
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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 These Presents That:
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Name of Property Owner/Applicant
Please note: If the property owner/applicant is an entity, the name of the entity should appear above.
If multiple persons own the prop rty or are applicants, an executed power of attorney from each owner will be needed.
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Mailing Address of Property Owner/Applicant Telephone Number
as owner of, or applicant with respect to, the tract(s) or parcel(s) of land in Frederick County,
Virginia, identified by following property identification numbers:
54 - A -- C17 6
do hereby make, constitute, and appoint:
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Name of Attorney -In -Fact
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Mailing Address of Attoniey-In-Fact ZLC,O Telephone Number
to act as my true and lawful attorney-in-fact for and in my name, place, and stead, with the same
full power and authority I would have if acting personally, to file and act on my behalf with respect
to appli tion with Frederick County, Virginia for the following, for the above identified property:
Rezoning ❑✓ Subdivision
Conditional Use Permit 0 Site Plan
Master Development Plan (prelim. or final) E] Variance or Zoning Appeal
and, further, 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 appointment shall expire one yearjrom the day that it is signed, or at such sooner time as I
otherwise rescind or modify it.
Signature
Title (if signing on behalf of an entity),r.
State oof y i req it ICL , County/City of To wit:
I, , 6af) 1I1 a Notary Public in and for the jurisdiction aforesaid, certify that
the person who signed the foregoing instrument personally appeared before me and has acknowledged the
same before mein the jurisdiction aforesaid this t+ day of h '20Z.
10"'�: Commission Expires:
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N tart' Publi TARV ��^ traton Number:
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