"Power of Attorney Form - the University of Tennessee Health Science Center" - City of Memphis, Tennessee

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Download "Power of Attorney Form - the University of Tennessee Health Science Center" - City of Memphis, Tennessee

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THE UNIVERSITY OF TENNESSEE 
                        Student   Loans
     
HEALTH SCIENCE CENTER                                                                        62 South Dunlap, Suite 107 
 
                                                                                      Memphis, TN  38163 
 
 
POWER OF ATTORNEY
STATE OF TENNESSEE
COUNTY OF SHELBY
KNOW ALL BY THOSE PRESENT, that I, ___________________________, of the City of Memphis, County of
Shelby, State of Tennessee, do hereby make, constitute and appoint _______________________ of the city of Memphis, County
of Shelby, State of Tennessee, my true and lawful attorney in fact for me and in my name, place and stead, and on my behalf, and
for my use and benefit to do the following:
1.
Pick up and receive any and all student financial aid checks of any and all kind whatsoever and to do any act
which would be necessary for me to do if I were personally present and acting in connection with any financial aid
checks, with full power of substitution and revocation, hereby ratifying and affirming that which my lawful
attorney in fact shall lawfully do or cause to be done by virtue of the power herein conferred.
2.
I further covenant and agree to hold harmless any person who may act in reliance upon the authority granted
herein to my attorney in fact.
3.
This power of attorney shall remain in full force and effect for a period of ______ days from the date signed
herein and shall expire by its own terms thereafter.
This power of attorney shall not be affected by subsequent disability or incapacity of the principal.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this _______ day of __________________, 20____.
___________________________________________
Student Signature
STATE OF TENNESSEE
COUNTY OF SHELBY
Personally
came
before
me,
this
______ day
of
_________________,
20____,
the
above named
___________________ to me known to be (or who was presented to me to be) the person who executed the foregoing instrument
and acknowledged the same.
________________________________________________
Notary Public, State of Tennessee
My Commission Expires: ___________________________
Print Form
THE UNIVERSITY OF TENNESSEE 
                        Student   Loans
     
HEALTH SCIENCE CENTER                                                                        62 South Dunlap, Suite 107 
 
                                                                                      Memphis, TN  38163 
 
 
POWER OF ATTORNEY
STATE OF TENNESSEE
COUNTY OF SHELBY
KNOW ALL BY THOSE PRESENT, that I, ___________________________, of the City of Memphis, County of
Shelby, State of Tennessee, do hereby make, constitute and appoint _______________________ of the city of Memphis, County
of Shelby, State of Tennessee, my true and lawful attorney in fact for me and in my name, place and stead, and on my behalf, and
for my use and benefit to do the following:
1.
Pick up and receive any and all student financial aid checks of any and all kind whatsoever and to do any act
which would be necessary for me to do if I were personally present and acting in connection with any financial aid
checks, with full power of substitution and revocation, hereby ratifying and affirming that which my lawful
attorney in fact shall lawfully do or cause to be done by virtue of the power herein conferred.
2.
I further covenant and agree to hold harmless any person who may act in reliance upon the authority granted
herein to my attorney in fact.
3.
This power of attorney shall remain in full force and effect for a period of ______ days from the date signed
herein and shall expire by its own terms thereafter.
This power of attorney shall not be affected by subsequent disability or incapacity of the principal.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this _______ day of __________________, 20____.
___________________________________________
Student Signature
STATE OF TENNESSEE
COUNTY OF SHELBY
Personally
came
before
me,
this
______ day
of
_________________,
20____,
the
above named
___________________ to me known to be (or who was presented to me to be) the person who executed the foregoing instrument
and acknowledged the same.
________________________________________________
Notary Public, State of Tennessee
My Commission Expires: ___________________________