THAT I,
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have made, constituted and appointed, and by these presents do make, constitute and appoint:
SUMMUM, a 501(c)(3) organization, and all authorized agents of SUMMUM, whose principal office is located at 707 Genesee Avenue, Salt lake City, Utah 84104,
a true and lawful attorney for me to ask, arrange, bargain, contract, and agree for, purchase and in any and every way and manner deal in and with the rites of Mummification and Transference, including but not limited to funeral, embalming, and interment arrangements and services, through a license _______________ state mortuary/funeral home with a licensed _______________ state embalmer, and to make, do and transact all and every kind of business of that nature and kind, and also for and in my name act and deed, to sign, seal, execute, deliver and acknowledge such deeds, covenants, indentures, agreements, receipts, and such other instruments in writing of that kind and nature.
GIVING AND GRANTING unto SUMMUM and all authorized agents of SUMMUM, said attorney full power and authority to do and perform all and every act and thing whatsoever requisite and necessary to be done in and about the premises, as fully to all intents and purposes as I might or could do if personally present, can be done by SUMMUM and all authorized agents of SUMMUM, hereby ratifying and confirming all that said attorney, SUMMUM and all authorized agents of SUMMUM, shall lawfully do or cause to be done by virtue of these presents.
IN WITNESS WHEREOF I have hereto set my hand and seal this _____ day of _______________, A.D. 20___.
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Signed, Sealed, and Delivered in the Presence of:
Witness: ________________________________________
Witness: ________________________________________
State of ______________________ )
)
County of ____________________ )
On this _____ day of _______________, 20___, personally appeared before me in and for said County,
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whose name is subscribed to the annexed instrument as part of thereto, personally known to me to be the same person so described in and who executed the said annexed instrument as part of thereto; and duly acknowledged to me that ___________________________________________ executed the same freely and voluntarily, and for the use and purposes therein mentioned.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my Seal at my office:
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the day and year in this Certificate first written above.
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Notary Public [Notary Seal]
My commission expires:
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