Authorization Letter Template

AUTHORIZATION LETTER

[Your Name]
[Your Address]
[City, State, ZIP Code]
[Phone Number]
[Email]

[Date]

[Recipient Organization Name]
[Department, if applicable]
[Address]
[City, State, ZIP Code]

Re: Authorization Letter
    Account/Reference Number: [IF APPLICABLE]
    Subject: Authorization for [PURPOSE]

To Whom It May Concern:

I, [YOUR FULL LEGAL NAME], hereby authorize [AUTHORIZED PERSON'S FULL NAME] to act on my behalf for the following purpose(s):

TYPE OF AUTHORIZATION:

☐ Collect documents on my behalf
☐ Sign documents on my behalf
☐ Make decisions regarding [SPECIFY]
☐ Access my account/records
☐ Pick up [ITEM/PACKAGE/PRESCRIPTION]
☐ Represent me in [MATTER]
☐ Conduct business transactions
☐ Receive information about my account
☐ Other: [Specify purpose]

SCOPE OF AUTHORIZATION:

This authorization is granted for the following specific purpose(s):

[Describe in detail what the authorized person is allowed to do. Be specific to avoid misuse.]

1. [Specific action authorized]
2. [Specific action authorized]
3. [Specific action authorized]

AUTHORIZATION DETAILS:

Authorized Person's Information:
Full Name: [AUTHORIZED PERSON'S FULL NAME]
Relationship to Me: [Spouse/Child/Attorney/Agent/etc.]
Phone: [PHONE NUMBER]
Address: [ADDRESS]
ID Type: [Driver's License / Passport / State ID]
ID Number: [ID NUMBER] (last 4 digits: [XXXX])

My Information (Authorizing Person):
Full Name: [YOUR FULL LEGAL NAME]
Date of Birth: [DATE OF BIRTH]
Address: [YOUR ADDRESS]
Phone: [YOUR PHONE]
Account/Reference #: [IF APPLICABLE]
ID Type: [Driver's License / Passport / State ID]
ID Number: [ID NUMBER] (last 4 digits: [XXXX])

DURATION OF AUTHORIZATION:

This authorization is valid:
☐ For a single use on [DATE]
☐ From [START DATE] to [END DATE]
☐ Until revoked in writing
☐ For [NUMBER] days from the date of this letter

LIMITATIONS:

This authorization does NOT include permission to:
☐ [Limitation 1 - e.g., Access financial accounts]
☐ [Limitation 2 - e.g., Make purchases]
☐ [Limitation 3 - e.g., Sign contracts]

IDENTIFICATION REQUIREMENT:

The authorized person will present the following identification when acting on my behalf:
☐ Valid driver's license
☐ Valid passport
☐ State-issued ID card
☐ Copy of this authorization letter
☐ [Other identification]

CONTACT FOR VERIFICATION:

If you need to verify this authorization, please contact me at:
Phone: [YOUR PHONE NUMBER]
Email: [YOUR EMAIL]
Best time to reach me: [TIME]

REVOCATION:

I reserve the right to revoke this authorization at any time by providing written notice to [ORGANIZATION NAME].

ACKNOWLEDGMENT:

I understand that I am responsible for any actions taken by the authorized person within the scope of this authorization. I confirm that the information provided in this letter is true and accurate.

Sincerely,

_________________________
[Your Signature]

[Your Printed Name]
[Date Signed]

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WITNESS (if required):

I witnessed the signing of this authorization letter.

Signature: _________________________
Printed Name: _________________________
Date: _________________________

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NOTARIZATION (if required):

State of ____________
County of ____________

On this ___ day of ____________, 20___, before me personally appeared [YOUR NAME], known to me to be the person whose name is subscribed to this instrument, and acknowledged that they executed the same for the purposes therein contained.

Notary Public: _________________________
Commission Expires: _________________________

[NOTARY SEAL]

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AUTHORIZED PERSON'S ACKNOWLEDGMENT:

I, [AUTHORIZED PERSON'S NAME], acknowledge that I have read and understand the scope and limitations of this authorization.

Signature: _________________________
Date: _________________________

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NOTES:

• Keep a copy of this letter for your records
• The authorized person should carry a copy and valid ID
• Some organizations require notarization for certain authorizations
• Consider limiting the duration and scope to prevent misuse