FOR THE __________ DISTRICT OF __________
To _________________ of _______________ (mailing address), and ____________ of _____________ (mailing address):
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 of the meeting, 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.
_________________________
Signature and Title
If appropriate By
Address:
(If executed by an individual) Acknowledged before me on __________.
(If executed on behalf of a partnership) Acknowledged before me on ___________, 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.
_______________________
Signature
_______________________
(Official character)
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