Form B11B 6/90
Form 11B. SPECIAL POWER OF ATTORNEY [Caption as in Form 16B] SPECIAL POWER OF ATTORNEY
To ________________________________________ of * _______________________________________, and
_____________________________________ of * ____________________________________________________. The undersigned claimant hereby authorizes you, or any one of you, as attorney in fact for the undersigned [if desired: and with full power of substitution,] to attend the meeting of creditors of the debtor or any adjournment thereof, and to vote in my behalf on any question that may be lawfully submitted to creditors at such meeting or adjourned meeting, and for a trustee or trustees of the estate of the debtor.
Dated: __________________________ Signed: ______________________________________________ By ___________________________________________ as ___________________________________________
Address: _____________________________________________ _________________________________________________
[If executed by an individual] Acknowledged before me on __________________________. [If executed on behalf of a partnership] Acknowledged before me ______________________________, by _____________________________, who says that he [or she] is a member of the partnership named above and is authorized to execute this power of attorney in its behalf. [If executed on behalf of a corporation] Acknowledged before me on ____________________________, by ____________________________, who says that he [or she] is _______________________________ of the corporation named above and is authorized to execute this power of attorney in its behalf.
[Official character.] * State mailing address.