HomeMy WebLinkAbout02-20 Power of Attorney4*G1C coG� Special Limited Power of Attorney
County of Frederick, Virginia
Frederick Planning Website: www.fcva.us
Department of Planning & Development, County of Frederick, Virginia
107 North Kent Street, Winchester, Virginia 22601
Phone (540) 665-5651 Facsimile (540) 665-6395
All Men By These Presents That:
Name of Property Owner/Applicant
Please note: If the property owner/applicnnl is an entity, the nnnre oflhc entity should appear above.
It multiple persons own the property or are appliciuus, an executed power of attorney from each o mer will be neled
t i� S(leRei µ.;fl t'dt".tt �x;tL
Mailing Address of Property Owner/Applicant Telephone Number
as owner of, or applicant with respect to, the tract(s) or pareel(s) of land in Frederick County,
Virginia, identified by following property identification numbers:
hereby make, constitute, and appoint:
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Name of Attorney -In -Fact
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Mailing Address or Attorney -In -Fact 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 application with Frederick County, Virginia for the following, for the above identified property:
Rezoning Subdivision
Conditional Use Permit Site Plan
Master Development Plan (prelim, or final) L] 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 year from the day that it is signed, or at such sooner time as I
otherwise rescind or modify it.
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Signature V'-"-
Title (if signing on behalf of an entity)
State of County/City of �, To wit:
I, Oi rl`i a, o1�% a Notary Public in and for the jurisdiction aforesaid, certify that
the person who signed th6foregoing instrument personally appeared before me and has acknowledged the
sarn 'before me in e�urisdiction aforesaid this �A___ day of v r�r �, 20
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