Power of Attorney form

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File: EFTA01299203_p2_i0.png dataset_10
Summary:

The image is a scanned Power of Attorney form from 'Jeepers INC', dated '10/23/B', with handwritten entries and marked as confidential. It includes fields for account holder information, signatures, and reference numbers.

Content Type:
Image
Document Type:
image
Date:
2013-10-23
Model Used:
gemini-2.0-flash-001
Image Classification
Category:
document_scan
Subcategory:
form
Objects Detected (1)
Form
A scanned form titled 'Power of Attorney'. It includes fields for account holder title, signatures, print names, and date.
Jeepers INC Account Holder Title Individual Joint, with Rights of Survivorship Signature Signature Signature Signature Approved Power of Attorney Specimen Signature Corporate Joint, Tenants in Common Partnership Limited Liability Corporation Other. Print Name Print Name Print Name Print Name Date Account Number Number of Signatures Required: Date of Power of Attorney
Scene & Environment

Setting: indoor

Location Type: office

Time: unclear

Atmosphere: formal

Document Extraction

Type: form

Date: 10/23/B

Letterhead: Jeepers INC

Key Points:

  • Power of Attorney
  • Account Holder Title
  • Signatures
  • Date

Full Transcription:

Je
Jeepers
INC
Account Holder Title
Individual ITF/POD/ATF* Corporate
Joint, with Rights Joint, Tenants in Common
of Survivorship Partnership Other.
Manre Jeanne Brennan
Print Name
Print Name
Print Name
Print Name
Signature
Signature
Signature
Signature
10/23/B
Date
Approved
Power of Attorney
Account Number
Number of Signatures
Required: 1
Date of Power of Attorney
Specimen Signature
* For ITF/POD/ATF See Supplemental Terms and Conditions
SDNY_GM_00064914
CONFIDENTIAL - PURSUANT TO FED. R.
CONFIDENTIAL
DB-SDNY-0027739
EFTA_00175414
006678.080913
13-AWM-0359
NAOSOD00015650-000105143
Text in Image
Je
Jeepers
INC
Account Holder Title
Individual
ITF/POD/ATF*
Corporate
Joint, with Rights
of Survivorship
Joint, Tenants
in Common
Partnership
Limited Liability
Corporation
Other.
Manre
Jeanne Brennan
Print Name
Print Name
Print Name
Print Name
Signature
Signature
Signature
Signature
10/23/B
Date
Approved
Power of Attorney
Account Number
Number of Signatures
Required:
Date of Power of Attorney
Specimen Signature
* For ITF/POD/ATF See Supplemental Terms and Conditions
SDNY_GM_00064914
CONFIDENTIAL - PURSUANT TO FED. R.
CONFIDENTIAL
DB-SDNY-0027739
EFTA_00175414
006678.080913
13-AWM-0359
NAOSOD00015650-000105143

Significance: The form is a legal document, and the text provides the structure and fields for the document.

Full Description

The image is a scanned document, specifically a Power of Attorney form. The form is mostly white with black printed text and some handwritten entries. At the top, the name 'Jeepers INC' is printed. The form includes sections for the account holder title, with options for 'Individual', 'Corporate', 'Joint with Rights of Survivorship', 'Joint Tenants in Common', 'Partnership', 'Limited Liability Corporation', and 'Other'. A handwritten name, 'Manre', is visible, along with the printed name 'Jeanne Brennan'. There are signature lines, and a handwritten date '10/23/B'. The bottom of the form includes the phrases 'Approved', 'Power of Attorney', and 'Specimen Signature'. The document is marked as 'CONFIDENTIAL - PURSUANT TO FED. R.' at the bottom left. Several reference numbers are also printed at the bottom. The image quality is medium, and the document is slightly rotated.

People
Jeanne Brennan
Organizations
Jeepers INC
Themes
Legal matters/litigation Business dealings
Raw Analysis