I, _________, of _________[street address], City of _________, County of _________, State of _________, constitute and appoint my _________[husband or wife], _________[name], of _________[street address], City of _________, County of _________, State of _________, my true and lawful attorney in fact, for me in my name, place, and stead to take possession of, manage, encumber, exchange, lease, or sell any and all real property now held, or which may be held, by me separately, severally, or jointly, with full power to sell and convey such property, or any interest in it.

The rights, powers, and authority of the attorney in fact to exercise any and all of the rights and powers granted shall commence and be in full force and effect on _________, 19__, and such rights, powers, and authority shall remain in full force and effect until _________[specify period of time, date of termination, contingency on which powers terminate, or method of termination, such as by written notice].

In witness, I have duly executed this instrument _________, 19__.

[Signature]

[Acknowledgment]