Power of Attorney

Instructions for Completing FSA-211A

Item Number/ Section	Instructions
	FSA-211A shall be used only when all of the following are met: grantor is an entity, such as a general partnership, joint venture, corporation, limited liability company, limited liability partnership, or other similar entity there is no 1 individual already authorized to act for the entity more than 2 member signatures are required. Number each continuation sheet consecutively. Example: If there are a total of 3 continuation sheets, they would be numbered “1 of 3”, “2 of 3”, and “3 of 3”, respectively. Important: All continuation sheets must be attached to applicable FSA-211.
1	Enter the name of the attorney-in-fact from FSA-211, item 1.
2	Enter the name of the entity from FSA-211, Item 5.
3, 4, 5, 6, 7 A through B	Individual members shall sign, and date.
3, 4, 5, 6, 7 C through E	At least 1 FSA employee must witness the grantor’s signature. FSA employee must verify the grantor’s identity by either personal knowledge or by reviewing the grantor’s government issued picture identification, like a valid driver license. Grantor’s signature may be notarized instead of witnessed by an FSA employee.
3, 4, 5, 6, 7 F	If the grantor’s signature is not witnessed by at least 1 FSA employee, the form must be acknowledged by a valid Notary Public. The Notary Public’s signature, State and county of commission, and certification are required. Important: One notary public signature may be accepted for multiple grantors only when the notary public clearly identifies each name of the grantor to which the notary applies. Example: Jane Smith, Joe Brown, and Bill Black each sign FSA-211A at the same time in the presence of the same notary public. The notary public signs FSA-211A only once and indicates the notary signature applies to all 3 grantor signatures by identifying each name of the individuals appearing before the notary public.