DURABLE POWER OF ATTORNEY
CAUTION TO THE PRINCIPAL: Your Power of Attorney is an important document. As the "principal", you give the person whom you choose (your "agent") authority to spend your money and sell or dispose of your property during your lifetime without telling you. You do not lose your authority to act even though you have given your agent similar authority.
When your agent exercises this authority, he or she must act according to any instructions you have provided or, where there are no specific instructions, in your best interest. "Important Information for the Agent" at the end of this document describes your agent's responsibilities.
Your agent can act on your behalf only after signing the Power of Attorney before a notary public.
You can request information from your agent at any time. If you are revoking a prior Power of Attorney, you should provide written notice of the revocation to your prior agent(s) and to any third parties who may have acted upon it, including the financial institutions where your accounts are located.
You can revoke or terminate your Power of Attorney at any time for any reason as long as you are of sound mind. If you are no longer of sound mind, a court can remove an agent for acting improperly.
Your agent cannot make health care decisions for you. You may execute a "Health Care Proxy" to do this.
The law governing Powers of Attorney is contained in the New York General Obligations Law, Article 5, Title 15. This law is available at a law library, or online through the New York State Senate or Assembly websites, www.nysenate.gov or www.nyassembly.gov.
If there is anything about this document that you do not understand, you should ask a lawyer of your own choosing to explain it to you.
I, _________, of _________, telephone number _________, and email address _________, hereby appoint _________ of _________, telephone number _________, and email address _________, as my agent ("Agent").
B. REVOCATION
This Power of Attorney DOES NOT REVOKE any Powers of Attorney previously executed by me unless I have stated otherwise below, under "Modifications".
I grant authority to my Agent(s) with respect to the following subjects as defined in sections 5-1502A through 5-1502N of the New York General Obligations Law:
(Initial the bracket at each authority you grant)
(____) Real estate transactions
(____) Chattel and goods transactions
(____) Bond, share, and commodity transactions
(____) Banking transactions
(____) Business operating transactions
(____) Insurance transactions
(____) Estate transactions
(____) Claims and litigation
(____) Personal and family maintenance
(____) Benefits from governmental programs or civil or military service
(____) Financial matters related to health care; records, reports, and statements
(____) Retirement benefit transactions
(____) Tax matters
(____) All other matters
(____) Full and unqualified authority to my agent(s) to delegate any or all of the foregoing powers to any person or persons whom my agent(s) select
In this section, you may make additional provisions, including, but not limited to, language to limit or supplement authority granted to your agent, language to grant your agent the specific authority to make gifts to himself of herself, and /or language to grant your agent the specific authority to make other gift transactions and/or changes to interests in your property. Your agent is entitled to be reimbursed from your assets for reasonable expenses incurred on your behalf. In this section, you may make additional provisions if you ALSO wish your agent(s) to be compensated from your assets for services rendered on your behalf, and you may define "reasonable compensation".
E. COMPENSATION OF AGENT(S)
My Agent(s) shall not be entitled to any compensation, during my lifetime or upon my death, for any services provided under this Statutory Power of Attorney.
F. ACCEPTANCE BY THIRD PARTIES
I agree to indemnify the third party for any claims that may arise against the third party because of reliance on this Power of Attorney. I understand that any termination of this Power of Attorney, whether the result of my revocation of the Power of Attorney or otherwise, is not effective as to a third party until the third party has actual notice or knowledge of the termination.
G. EFFECTIVE DATE AND TERMINATION
This Power of Attorney takes effect immediately, and will not be affected by my disability or lack of mental competence, except as may be provided otherwise by an applicable state statute. This is a Durable Power of Attorney.
This Power of Attorney continues until I revoke it or it is terminated by my death or other event described in section 5-1511 of the General Obligations Law.
Section 5-1511 of the General Obligations Law describes the manner in which you may revoke your Power of Attorney, and the events which terminate the Power of Attorney.
This Durable Power of Attorney may be revoked or terminated by me at any time or for any reason as long as I am sound of mind.
SIGNATURE AND ACKNOWLEDGMENT
In Witness Whereof I have hereunto signed my name on the _____ day of ___________, 20__, at _________, _________.
PRINCIPAL signs here: | _______________________________ |
| _________ |
ss.
On the _____ day of ___________, 20__, before me, the undersigned, personally appeared _______________________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity, and that by his/her signature on the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument.
| _____________________________ |
| Notary Signature |
By signing as a witness, I acknowledge that the principal signed the Power of Attorney in my presence and in the presence of the other witness, or that the principal acknowledged to me that the principal's signature was affixed by him or her or at his or her direction. I also acknowledge that the principal has stated that this Power of Attorney reflects his or her wishes and that he or she has signed it voluntarily. I am not named herein as an agent or as a permissible recipient of gifts.
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____________________________ | ____________________________ |
Signature of witness 1 | Signature of witness 2 |
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Date: _____________________ | Date: _____________________ |
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Print Name: _________ | Print Name: _________ |
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Address: _________ | Address: _________ |
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IMPORTANT INFORMATION FOR THE AGENT
When you accept the authority granted under this Power of Attorney, a special legal relationship is created between you and the principal. This relationship imposes on you legal responsibilities that continue until you resign or the Power of Attorney is terminated or revoked. You must:
(1) act according to any instructions from the principal, or, where there are no instructions, in the principal's best interest;
(2) avoid conflicts that would impair your ability to act in the principal's best interest;
(3) keep the principal's property separate and distinct from any assets you own or control, unless otherwise permitted by law;
(4) keep a record or all receipts, payments, and transactions conducted for the principal; and
(5) disclose your identity as an agent whenever you act for the principal by writing or printing the principal's name and signing your own name as "agent" in either of the following manners: (Principal's Name) by (Your Signature) as Agent, or (your signature) as Agent for (Principal's Name).
You may not use the principal's assets to benefit yourself or anyone else or make gifts to yourself or anyone else unless the principal has specifically granted you that authority in this document, which is either a Statutory Gifts Rider attached to a Statutory Short Form Power of Attorney or a Non-Statutory Power of Attorney. If you have that authority, you must act according to any instructions of the principal or, where there are no such instructions, in the principal's best interest.
You may resign by giving written notice to the principal and to any co-agent, successor agent, monitor if one has been named in this document, or the principal's guardian if one has been appointed. If there is anything about this document or your responsibilities that you do not understand, you should seek legal advice.
Liability of agent: The meaning of the authority given to you is defined in New York's General Obligations Law, Article 5, Title 15. If it is found that you have violated the law or acted outside the authority granted to you in the Power of Attorney, you may be liable under the law for your violation.
AGENT'S SIGNATURE AND ACKNOWLEDGMENT OF APPOINTMENT
I _______________________________, have read the foregoing Power of Attorney. I am the person identified therein as agent for the principal named therein.
I acknowledge my legal responsibilities.
In Witness Whereof I have hereunto signed my name on the _____ day of ___________, 20__.
Agent signs here: | _______________________________ |
| _________ |
ss.
On the _____ day of ___________, 20__, before me, the undersigned, personally appeared _______________________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity, and that by his/her signature on the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument.
| _____________________________ |
| Notary Signature |