MINNESOTA SHORT FORM POWER OF ATTORNEY
Before completing and signing this form, the principal must read and initial the IMPORTANT NOTICE TO PRINCIPAL that appears after the signature lines in this form. Before acting on behalf of the principal, the attorney(s)-in-fact must sign this form, acknowledging having read and understood the IMPORTANT NOTICE TO ATTORNEY(S)-IN-FACT that appears after the notice to the principal.
DESIGNATION OF AGENT
I, _________, with permanent residence address at _________, telephone number _________, and email address _________, name the following person as my agent:
Name of Agent: _________
Agent's Address: _________
Agent's Telephone Number: _________
Agent's Email Address: _________
DURABLE POWER OF ATTORNEY
GRANT OF GENERAL AUTHORITY
I grant my agent and any successor agent general authority to act for me with respect to the following subjects as defined in the Uniform Power of Attorney Act:
(To grant to the attorney-in-fact any of the following powers, make a check or "x" on the line in front of each power being granted. You may, but need not, cross out each power not granted. Failure to make a check or "x" on the line in front of the power will have the effect of deleting the power.)
________ Real property transactions
________ Tangible personal property transactions
________ Bond, share and commodity transactions
________ Banking transactions
________ Business operating transactions
________ Insurance transactions
________ Beneficiary transactions
________ Gift transactions
________ Fiduciary transactions
________ Claims and litigation
________ Family maintenance
________ Benefits from military service
________ Records, reports and statements
LIMITATION ON AGENT'S AUTHORITY
An agent that is not my ancestor, spouse, or descendant MAY NOT use my property to benefit the agent or a person to whom the agent owes an obligation of support unless I have included that authority in the Special Instructions.
My attorney(s)-in-fact must NOT render accounting to me, my personal guardian or conservator, or to anyone I deem my representative on these matters.
My Agent is entitled to reasonable compensation for services rendered as my Agent.
My Agent is entitled to reimbursement for reasonable expenses incurred in acting under this Power of Attorney.
This power of attorney shall be effective immediately and will continue to be effective until my death, even if I became incapacitated, except as may be provided otherwise by an applicable state statute.
This Power of Attorney may be revoked or terminated by me at any time by providing written notice to my Agent.
RELIANCE ON THIS POWER OF ATTORNEY
Any person, including my agent, may rely upon the validity of this power of attorney or a copy of it unless that person knows it has terminated or is invalid.
In witness whereof I have hereunto signed my name this __ day of _________, ____, at _________, Minnesota.
| ________________________________________ |
| (Signature of Principal) |
Address: _________
Telephone Number: _________
Email Address: _________Acknowledgment of notice to attorney(s)-in-fact and specimen signature
of attorney(s)-in-fact
By signing below, I acknowledge I have read and understand the IMPORTANT NOTICE TO ATTORNEY(S)-IN-FACT required by Minnesota Statutes, section 523.23, and understand and accept the scope of any limitations to the powers and duties delegated to me by this instrument.
Specimen Signature of Attorney(s) in Fact:
___________________________________ | _______________ |
_________ | Date |
STATE OF MINNESOTA | ) |
| ) ss |
COUNTY OF _________ | ) |
The foregoing instrument was acknowledged before me this __ day of _________, ____,
by _________
| ________________________________________ |
| (Signature of Notary Public or other Official) |
IMPORTANT NOTICE TO THE PRINCIPAL
READ THIS NOTICE CAREFULLY. The power of attorney form that you will be signing is a legal document. It is governed by Minnesota Statutes, chapter 523. If there is anything about this form that you do not understand, you should seek legal advice.
PURPOSE: The purpose of the power of attorney is for you, the principal, to give broad and sweeping powers to your attorney(s)-in-fact, who is the person you designate to handle your affairs. Any action taken by your attorney(s)-in-fact pursuant to the powers you designate in this power of attorney form binds you, your heirs and assigns, and the representative of your estate in the same manner as though you took the action yourself.
POWERS GIVEN: You will be granting the attorney(s)-in-fact power to enter into transactions relating to any of your real or personal property, even without your consent or any advance notice to you. The powers granted to the attorney(s)-in-fact are broad and not supervised. THIS POWER OF ATTORNEY DOES NOT GRANT ANY POWERS TO MAKE HEALTH CARE DECISIONS FOR YOU. TO GIVE SOMEONE THOSE POWERS, YOU MUST USE A HEALTH CARE DIRECTIVE THAT COMPLIES WITH MINNESOTA STATUTES, CHAPTER 145C.
DUTIES OF YOUR ATTORNEY(S)-IN-FACT: Your attorney(s)-in-fact must keep complete records of all transactions entered into on your behalf. You may request that your attorney(s)-in-fact provide you or someone else that you designate a periodic accounting, which is a written statement that gives reasonable notice of all transactions entered into on your behalf. Your attorney(s)-in-fact must also render an accounting if the attorney-in-fact reimburses himself or herself for any expenditure they made on behalf of you.
An attorney-in-fact is personally liable to any person, including you, who is injured by an action taken by an attorney-in-fact in bad faith under the power of attorney or by an attorney-in-fact's failure to account when the attorney-in-fact has a duty to account under this section. The attorney(s)-in-fact must act with your interests utmost in mind.
TERMINATION: If you choose, your attorney(s)-in-fact may exercise these powers throughout your lifetime, both before and after you become incapacitated. However, a court can take away the powers of your attorney(s)-in-fact because of improper acts. You may also revoke this power of attorney if you wish. This power of attorney is automatically terminated if the power is granted to your spouse and proceedings are commenced for dissolution, legal separation, or annulment of your marriage.
This power of attorney authorizes, but does not require, the attorney(s)-in-fact to act for you. You are not required to sign this power of attorney, but it will not take effect without your signature. You should not sign this power of attorney if you do not understand everything in it, and what your attorney(s)-in-fact will be able to do if you do sign it.
Please place your initials on the following line, indicating you have read this IMPORTANT NOTICE TO THE PRINCIPAL:
INITIALS: ____________
IMPORTANT NOTICE TO THE ATTORNEY(S)-IN-FACT
Agent's Duties
You have been nominated by the principal to act as an attorney-in-fact. You are under no duty to exercise the authority granted by the power of attorney. However, when you do exercise any power conferred by the power of attorney, you must:
(1) Act with the interests of the principal utmost in mind;
(2) Exercise the power in the same manner as an ordinarily prudent person of discretion and intelligence would exercise in the management of the person's own affairs;
(3) Render accounting as directed by the principal or whenever you reimburse yourself for expenditures made on behalf of the principal;
(4) Act in good faith for the best interest of the principal, using due care, competence, and diligence;
(5) Cease acting on behalf of the principal if you learn of any event that terminates this power of attorney or terminates your authority under this power of attorney, such as revocation by the principal of the power of attorney, the death of the principal, or the commencement of proceedings for dissolution, separation, or annulment of your marriage to the principal;
(6) Disclose your identity as an attorney-in-fact whenever you act for the principal by signing in substantially the following manner:
________________________________________________________________________
(Principal's Name) by (Your Signature) as Agent
(7) Acknowledge you have read and understood this IMPORTANT NOTICE TO THE ATTORNEY(S)-IN-FACT by signing the power of attorney form.
You are personally liable to any person, including the principal, who is injured by an action taken by you in bad faith under the power of attorney or by your failure to account when the duty to account has arisen.
The meaning of the powers granted to you is contained in Minnesota Statutes, chapter 523. If there is anything about this document or your duties that you do not understand, you should seek legal advice.
Termination of Agent's Authority
You must stop acting on behalf of the principal if you learn of any event that terminates this power of attorney or your authority under this power of attorney. Events that terminate a power of attorney or your authority to act under a power of attorney include:
(1) Death of the principal;
(2) The principal's revocation of the power of attorney or your authority;
(3) The occurrence of a termination event stated in the power of attorney;
(4) The purpose of the power of attorney is fully accomplished; or
(5) If you are married to the principal, a legal action is filed with a court to end your marriage, or for your legal separation, unless the Special Instructions in this power of attorney state that such an action will not terminate your authority.
Liability of Agent
The meaning of the authority granted to you is defined in the Uniform Power of Attorney Act. If you violate the Uniform Power of Attorney Act or act outside the authority granted, you may be liable for any damages caused by your violation.
If there is anything about this document or your duties that you do not understand, you should seek legal advice.
AFFIDAVIT OF ATTORNEY-IN-FACT AS CONCLUSIVE PROOF OF NON-TERMINATION AND NON-REVOCATION IN REAL PROPERTY TRANSACTIONS
STATE OF MINNESOTA | ) |
| ) ss |
COUNTY OF _________ | ) |
_________, being first duly sworn on oath says that:
1. Affiant is the Attorney-in-Fact (or agent) named in that certain Power of Attorney dated __________________, and filed for record __________________, as Document No. __________________ (or in Book __________________ of __________________ Page __________________), in the Office of the County Recorder or Registrar of Titles of _________ County, Minnesota, executed by _________ as Grantor and Principal, relating to real property in _________ County, Minnesota, legally described as follows:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
(If more space is needed, continue on back or on an attachment.)
2. Affiant does not have actual knowledge and has not received actual notice of the revocation or termination of the Power of Attorney by Grantor's death, incapacity, incompetence, or otherwise, or notice of any facts indicating the same.
3. Affiant has examined the legal description(s) if any, attached to said Power of Attorney, and certifies that the description(s) has (have) not been changed, replaced, or amended subsequent to the signing of said Power of Attorney by the Principal. If so, please confirm this below:
___________________________________
_________, Affiant
Subscribe and sworn to before me
this __ day of _________, ____,
| ________________________________________ |
| (Signature of Notary Public or other Official) |
Notary Stamp or Seal
This instrument was drafted by:
________________________________________
________________________________________
________________________________________