,P[] ,( ,ATTORNEY ,= ,! ,G5]AL1
     ,$UC,NAL & ,M$ICAL ,C>E ,( ,AN
             ,ADULT ,/UD5T

  ,P[] ( ,ATTORNEY = MY C>E & MA9T5.E
:ILE ,I AM A /UD5T AT ! ,TEXAS ,S*OOL =!
,BL & ,VISU,Y ,IMPAIR$ 7,,TSBVI71 MADE ?
---- "D ( ----1 #BJ--4
  ,I1 ---- 79S]T "N ( /UD5T71 H MADE1
3/ITUT$ & APPO9T$1 & "HBY MAKE1 3/ITUTE
& APPO9T Z MY AG5T 6MAKE ANY & ALL
G5]AL1 $UC,NAL & H1L? C>E DECI.NS = ME1
& TAKE :AT"E /EPS & AC;NS MAY 2 REQUIR$
0! ,,TSBVI = PURPOSES ( MY 5ROLL;T &_/OR
S*OOL+1 EXCEPT 6! EXT5T ,I /ATE O!RWISE
9 ? DOCU;T4 ,I AM OV] ! AGE ( #AH YE>S &
"U NO GU>DIAN%IP OR 9CAPAC;Y2 ,I AM
QUALIFI$ 6MAKE ? APPO9T;T4 ,? P[] (
ATTORNEY IS BO? A G5]AL ALL-PURPOSE1
$UC,NAL & M$ICAL P[] ( ATTORNEY 7"H9
CALL$ EI G5]AL OR M$ICAL P[] ( ATTORNEY
& ^! T]MS >E US$ 9T]*ANGEABLY74 ,? G5]AL
& M$ICAL P[] ( ATTORNEY TAKES E6ECT IF
,I 2COME UNA# 6MAKE MY [N H1L? C>E OR
$UC,NAL DECI.NS1 & ? FACT IS          #A
C]TIFI$ 9 WRIT+ 0A PHYSICIAN OR ANY O!R
M$ICAL PRACTI;N]1 9CLUD+ A LIC5S$ NURSE
OR EM]G5CY M$ICAL P]SON 7,,EMS71 OR ,I
AM O!RWISE 9CAPACITAT$ OR UNA# 6MAKE MY
[N $UC,NAL DECI.NS1 = :AT"E R1SON1 Z
DET]M9$ 0ANY /AFF MEMB] ( ,,TSBVI1 9
HIS1 H] OR _! SOLE & ABSOLUTE 4CRE;N4
  ,0? DOCU;T1 ,I "HBY APPO9T1 ---- 7"N (
AG5T71 :O RESIDES AT ---- 7A4RESS3
/REET1 C;Y & /ATE 79CLUD$ ZIP CODE71 &
^: TELEPH"O NUMB] IS3 ---- 79S]T A PH"O
NUMB]1 &1 IF AVAILA# AN ALT]NATIVE PH"O
NUMB]71 & IS RELAT$ 6ME Z MY ---- 79S]T
REL,N%IP1 = EXAMPLE1 P>5T1 GR&P>5T OR
FR1 ETC41 6BE "ND Z AG5T77' 7"H9AF CALL$
AG5T71 Z MY TRUE & LAW;L ATTORNEY 9 FACT
6ACT = ME & 9 MY "N 9 ANY WAY T ,I CD
ACT 9 P]SON4 ,I AM A /UD5T 7OR AM 5ROLL+
OR ATTEMPT+ 65ROLL7 AT ! ,,TSBVI1 & ?
P[] ( ATTORNEY IS =! PURPOSE ( 9SUR+ T
IF ,I _C MAKE A M$ICAL OR $UC,N DECI.N1
= :AT"E R1SON1 MY AG5T C ACT 6MAKE S*
DECI.N1 &1 :5"E NEC1 SIGN M$ICAL OR
$UC,N AU?ORIZ,NS OR P]MIS.NS ON MY
2HALF4                                #B
  ,MY AG5T MAY TAKE 9 MY "N1 OR 9 8 OR
H] [N "N1 ANY & ALL AC;NS & EX]CISE ANY
& ALL P[]S T ,I CD TAKE OR EX]CISE =!
PURPOSE ( MY ATT5D.E AT ,,TSBVI1 OR = MY
GD & WELF>E1 9CLUD+1 B N LIMIT$ TO1
>RANG+ =1 OR 3S5T+ TO1 M$ICAL1 D5TAL1 &
M5TAL H1L? TR1T;T1 & AU?ORIZ+ & SIGN+
ALL H1L? & M$ICAL =MS1 DOCU;TS OR
RECORDS1 9CLUD+1 0WAY ( EXAMPLE1 SIGN+
ANY =M REQUIR$ 0! ,H1L? ,9SUR.E
,PORTABIL;Y & ,A3.TABIL;Y ,ACT1 ,,PL
#AJD-AIA1 #AAJ ,/AT #AICF 7,AUGU/ #BA1
#AIIF7 78,,HIPAA074 ,I 9T5D ? 6BE BO? A
G5]AL P[] ( ATTORNEY &A DURA# M$ICAL P[]
( ATTORNEY4 ,I % SPECIFY C]TA9 ACTS : MY
ATTORNEY 9 FACT IS AU?ORIZ$ 6D 9 MY
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? P[]4 ,I 9T5D T MY ATTORNEY 9 FACT % H
! P[] 6EX]CISE OR P]=M ANY ACT1 P[]1
DUTY1 "R1 OR OBLIG,N :ATSO"E T ,I N[ H1
OR MAY "HAF ACQUIRE ! LEGAL "R1 P[]1 OR
CAPAC;Y 6EX]CISE OR P]=M1 9 3NEC;N )1
>IS+ F1 OR RELAT+ 6ANY P]SON1 ITEM1
TRANSAC;N1 ?+1 BUSI;S1 PROP]TY1 R1L OR
P]SONAL1 TANGI# OR 9TANGI#1 OR        #C
MATT] :ATSO"E4 ,AM;G ! "RS "HBY GRANT$
>E1 B 0WAY ( EXAMPLE ONLY & N 0WAY (
LIMIT,N3

7,A7 ,5ROLL ME 9 S*OOL & 9
  EXTRACURRICUL> ACTIVITIES1 H A3ESS
  6S*OOL RECORDS1 & MAY 4CLOSE ! 3T5TS
  6O!RS2
7,B7 ,>RANGE =& 3S5T 6M$ICAL1 D5TAL1 &
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7,C7 ,PROVIDE = MY FOOD1 LODG+1 RECRE,N1
  & TRAVEL2
7,D7 ,RCV & 4CUSS MY CLASS "W ) ANY
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7,E7 ,EXAM9E & RCV COPIES ( MY ,,TSBVI
  RECORDS2 REPORT C>DS2 S*OOL RECORDS1 9
  G5]AL2 SPECIAL $UC,N RECORDS & =MS1
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  DELIB],NS & =MS2 & O!R DOCU;T,N
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  C\RSE ( XS BUSI;S2                  #D
7,F7 ,GIVE P]MIS.N = MY "PICIP,N 9 V>I\S
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7,G7 ,6BE NOTIFI$ ( MY M$ICAL PRO#MS OR
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7,H7 ,6BE NOTIFI$ & 3SULT$ 3C]N+ MY
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  RESPONSIBILITIES1 & PRIVILEGES NORM,Y
  AF=D$ 6! P>5TS ( /UD5TS AT ,,TSBVI1
  9CLUD+1 B N LIMIT$ TO1 ! DUTY ( 5SUR+
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  6H\SE & FE$ ME DUR+ S* "TS Z ,I AM N
  PHYSIC,Y AT ,,TSBVI1 9 G5]AL1 &1 9
  "PICUL>1 DUR+ SPR+ & HOLI"D         #E
  BR1KS1 VAC,NS & WEEK5DS2
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  ,PROGRAM 7,,IEP71 OR 6TAKE OR AU?ORIZE
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  ALL[$ 0,SEC;N #EJD OR ! ,9DIVIDUALS )
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  CASE MAY BE2 & TO
7,M7 ,C>RY \ ANY A4I;NAL P[]S Z FOLL[S
  70WAY ( EXAMPLE & N 0WAY ( LIMIT,N73
7,N7 ,6D1 TAKE1 & P]=M ALL & E ACT & ?+
  :ATSO"E REQUISITE1 PRIOR1 OR NEC 6BE
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  "H9 GRANT$1 Z FULLY 6ALL 9T5TS &
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  PRES5T1 "HBY RATIFY+ & 3FIRM+ ALL T MY
  ATTORNEY 9 FACT % LAW;LLY D OR CAUSE
  6BE D"O 0VIRTUE ( ? P[] ( ATTORNEY &!
  "R & P[]S "H9 GRANT$4

                                      #F
  ,? 9/RU;T IS 6BE 3/RU$ & 9T]PRET$ Z
BO? A G5]AL P[] ( ATTORNEY &A DURA#
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SPECIFIC ITEMS1 "RS1 ACTS1 OR P[]S "H9
IS N 9T5D$ TO1 NOR DOES X1 LIMIT OR
RE/RICT1 & IS N 6BE 3/RU$ OR 9T]PRET$ Z
LIMIT+ OR RE/RICT+1 ! G5]AL &_/OR M$ICAL
P[]S "H9 GRANT$ 6MY ATTORNEY 9 FACT4

   ,! P[]S GRANT$ ABV % N 9CLUDE !
FOLL[+ P[]S OR % 2 SUBJECT 6! FOLL[+
RULES OR LIMIT,NS 7"H Y MAY 9CLUDE ANY
SPECIFIC LIMIT,NS T Y DEEM APPROPRIATE73

#A4 #A4 ,IF ,I AM N 9CAPACITAT$ OR
  O!RWISE UNA# 6DET]M9E MY [N BE/ 9T]E/
  Z JO9TLY DET]M9$ 0ANY AU?ORIZ$ P]SON
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  AG5T % N H ! AU?OR;Y 6C.T]M& ANY
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  MADE 0ME1 UN.S S* PREVI\S DECI.N %D
  A6ECT MY ABIL;Y 6ATT5D ,,TSBVI4

#B4 ----                              #G
  ,I AM FULLY 9=M$ Z 6ALL (! 3T5TS ( ?
=M & ,I "U/& ! FULL IMPORT ( ? GRANT (
P[]S 6! AG5T4
  ,I "HBY GRANT 6! AG5T ANY & ALL P[]S
6MANAGE MY PROP]TY & A6AIRS Z -PLETELY Z
,I MI<T D IF P]SON,Y PRES5T1 9CLUD+ B N
LIMIT$ 6EX]CIS+ ! P[]S SET =? ABV T ,I
WD H1 S L;G Z ,I AM 5ROLL$ Z A /UD5T AT
,,TSBVI4
  ,I C]TIFY T ,I AM EMANCIPAT$2 H["E1 ?
P[] ( ATTORNEY % 2 B9D+ & 5=CEA# S L;G Z
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9CLUD+ DUR+ S* BR1KS 9 ATT5D.E DUR+
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HOLI"DS4
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EXECUT$ =! PRIM>Y PURPOSE ( UNLAW;LLY
5ROLL+ 9 ,,TSBVI S T ,I MI<T "PICIPATE 9
! ACADEMIC OR 9T]S*OLA/IC A?LETIC
PROGRAMS PROVID$ 0,,TSBVI4
  ,I DCL "U P5ALTY ( P]JURY "U ! LAWS (!
,/ATE ( ---- 7,9S]T "N ( /ATE ": ! =M IS
6BE EXECUT$7 T ! =EGO+ IS TRUE &
CORRECT4
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,/ATE ( ----2 H["E1 XS VALID;Y1 3/RUC;N1
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? 3TRACT & 9DEP5D5T ( ANY O!R CLAIM OR
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9DEF9ITELY F ! DATE ,I EXECUTE ? DOCU;T
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H1L? C>E DECI.NS = MYF :5 ? P[] (
ATTORNEY EXPIRES1 ! AU?OR;Y ,I H GRANT$
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FOLL[+ DATE3 ----4 ,I "U/& T 05D+ ? P[]
( ATTORNEY )\T EXECUT+ A NEW DESIGN,N (
AN AG5T1 ,I MI<T 2 45ROLL$ F ATT5D+
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S* S*OOL4
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P[] ( ATTORNEY4                       #I
  ,IF ANY "P1 CLAUSE1 PROVI.N1 OR 3DI;N
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  ,ANY P]SON1 9CLUD+ MY AG5T1 MAY RELY
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COPY ( X UN.S T P]SON "KS T ! P[] (
ATTORNEY HAS BE5 T]M9AT$ OR IS 9VALID4
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ATTORNEY1 REG>D.S ( XS VALID;Y "U ! LAW
OR IF O!RWISE REVOK$ 7UN.S S* ?IRD "PY
HAS NOTICE ( XS 9VALIDLY OR REVOC,N71 &!
AC;NS (! AG5T : >E R1SONABLY )9 ! SCOPE
(! AG5T'S AU?OR;Y & MAY 5=CE ANY OBLIG,N
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#A4 ,! P[] ( ATTORNEY 0 O!RWISE G5U9E1
  VALID1 & / 9 E6ECT2 &
#B4 ,! AG5T'S AU?OR;Y 0 G5U9E1 VALID1 &
  / 9 E6ECT4                         #AJ

  ,69DUCE ANY ?IRD "PY 6ACT "H"U1 ,I
"HBY AGREE T ANY ?IRD "PY RCVG A COPY OR
FACSIMILE ( ? 9/RU;T MAY ACT "H"U1 & T
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6S* ?IRD "PY UN.S & UNTIL ACTUAL NOTICE
OR K ( S* REVOC,N OR T]M9,N % H BE5 RCVD
0S* ?IRD "PY1 & ,I = MYF &= MY HEIRS1
EXECUTORS1 LEGAL REPRES5TATIVES &
ASSIGNS1 "HBY AGREE 69DEMNIFY & HOLD
H>M.S ANY S* ?IRD "PY F & AG/ ANY & ALL
CLAIMS T MAY >ISE AG/ S* ?IRD "PY 0R1SON
( S* ?IRD "PY HAV+ RELI$ ON ! PROVI.NS (
? 9/RU;T4
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,4TRICT ,C\RT = ,TRAVIS ,C.TY1 ,TEXAS1
&= ? PURPOSE EA* "PY "HBY EXPRESSLY &
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,ATTORNEY 6BE A TRUE COPY ( ? ,P[] (
,ATTORNEY1 & EA* COPY OR DUPLICATE   #AA
% H ! SAME =CE & E6ECT Z AN ORIG9AL2 T
IS1 A PHOTOCOPY1 DUPLICATE1 REPRODUC$ OR
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ORIG9AL C.T]"P ( ? DURA# P[] ( ATTORNEY4
,MY ,AG5T IS AU?ORIZ$ 6MAKE PHOTOCOPIES
OR DUPLICATES ( ? 9/RU;T Z FREQU5TLY & 9
S* QUANT;Y Z MY AG5T % DEEM APPROPRIATE1
& EA* PHOTOCOPY & DUPLICATE % H ! SAME
=CE & E6ECT Z ! ORIG9AL4 ,ANY"O MAY RELY
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6BE MY AG5T--IN--FACT "H"U4
  ,7,Y >E N REQUIR$ 6DESIGNATE ANY
ALT]NATE AG5TS B Y MAY D S4 ,ANY
ALT]NATE AG5T Y DESIGNATE W 2 A# 6MAKE !
SAME H1L? C>E DECI.NS Z ! AG5T Y "H9BE=E
DESIGNAT$1 9 ! EV5T T AG5T IS UNA# OR
9ELIGI# 6ACT Z YR AG5T4 ,IF ! AG5T Y
DESIGNAT$ IS YR SP\SE1 HE OR %E 2COMES
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4SOLV$47'
  ,IF ! P]SON DESIGNAT$ Z MY AG5T 9
P>AGRAPH 7#A7 IS N AVAILA# OR 2COMES
9ELIGI# 6ACT Z MY AG5T 6MAKE ANY     #AB
$UC,NAL1 G5]AL OR H1L? C>E DECI.N OR
DECI.NS = ME OR LOSES ! M5TAL CAPAC;Y
6MAKE EI G5]AL1 $UC,NAL OR H1L? C>E
DECI.NS = ME1 OR IF ,I REVOKE T P]SON'S
APPO9T;T OR AU?OR;Y 6ACT Z MY AG5T 6MAKE
G5]AL1 $UC,NAL OR H1L? C>E DECI.NS = ME1
!N ,I DESIGNATE & APPO9T ! FOLL[+ P]SONS
6S]VE Z MY AG5T 6MAKE G5]AL1 $UC,NAL OR
H1L? C>E DECI.NS = ME Z AU?ORIZ$ 9 ?
DOCU;T1 S* P]SONS 6S]VE 9 ! ORD] LI/$
2L3

,F/ ,ALT]NATE ,AG5T3 ---- 7,9S]T "N1
  A4RESS1 & TELEPH"O NUMB] ( F/ ALT]NATE
  AG5T7
,SECOND ,ALT]NATE ,AG5T3 ---- 7,9S]T "N1
  A4RESS1 & TELEPH"O NUMB] ( SECOND
  ALT]NATE AG5T7

  ,"H91 ! S+UL> ( ANY ^W 9CLUDES !
PLURAL1 & VICE V]SA1 & ^WS ( ANY G5D]
9CLUDES ! MASCUL9E1 FEM99E & NEUT]
G5D]S4
   
                                     #AC
,/UD5T'S ,SIGNATURE3 ----
,PR9T$ "N3 ----
,SIGN$ & S1L$ 9 ! PRES;E (3
  ---- ,NOT>Y PUBLIC
,MY -MIS.N EXPIRES ----

    ,,A4I;NAL ,,9=M,N3
  7,! FOLL[+ % N H ANY LEGAL E6ECT OR 2
US$ 9 ! 9T]PRET,N ( ANY PROVI.N OR
PROVI.NS (! ABV ,P[] ( ,ATTORNEY4 ,X IS
9CLUD$ "H9 SOLELY Z A GUIDE =1 & 3V5I;E
6! ,"PIES2 & % N 2 DEEM$ "P (! 3T5TS (!
P[] ( ATTORNEY7
  ,6! AG5T DESIGNAT$ Z ATTORNEY 9 FACT3

7#A7 ,IF A *ANGE 9 CIRCUM/.ES RESULTS 9
  MY N LIV+ ) Y = M ?AN SIX WEEKS DUR+ A
  S*OOL T]M & S* *ANGE IS N DUE
  6HOSPITALIZ,N1 VAC,N1 /UDY ABROAD1 OR
  "S R1SON O!RWISE A3EPTA# 6! S*OOL1 Y
  %D NOTIFY ,,TSBVI 9 WRIT+4
7#B7 ,Y H ! AU?OR;Y 6ACT ON MY 2HALF
  UNTIL ,I REVOKE ! P[] ( ATTORNEY 9
  WRIT+ & PROVIDES NOTICE ( REVOC,N 6Y4
7#C7 ,Y MAY RESIGN Z AG5T 0NOTIFY+   #AD
  ME 9 WRIT+ 0C]TIFI$ MAIL OR /ATUTORY
  OV]NI<T DELIV]Y1 RETURN RECEIPT
  REQUE/$1 & IF Y 2COME UNA# 6C>E = ME
  :ILE ,I AM 9 ATT5D.E AT ,,TSBVI1 Y %
  CAUSE S* RESIGN,N 6BE -MUNICAT$ 6ME )A
  COPY 6,,TSBVI4


















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