Notice: The powers granted by this document are broad and sweeping. They are defined in the Connecticut Uniform Power of Attorney Act, which expressly permits the use of any other or different form of power of attorney desired by the parties concerned. The grantor of any power of attorney, the agent or such other person or entities as authorized by statute may make application to a Probate Court for an accounting as provided in subsection (d) of section 45a-175 of the general statutes. This power of attorney does not authorize the agent to make health care decisions for you.
If you have questions about the power of attorney or the authority you are granting to your agent, you should seek legal advice before signing this form.
Know All Persons by These Presents, which are intended to constitute a GENERAL POWER OF ATTORNEY pursuant to the Connecticut Uniform Power of Attorney Act:
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:
- Real property
- Tangible personal property
- Stocks and bonds
- Commodities and options
- Banks and other financial institutions
- Operation of entity or business
- Insurance and annuities
- Estates, Trusts, and Other Beneficial Interests
- Claims and Litigation
- Personal and Family Maintenance
- Benefits from governmental programs or civil or military service
- Retirement plans
- Taxes
LIMITATION ON AGENT'S AUTHORITY
An agent MAY NOT use my property to benefit the agent or a dependent of the agent, except to the extent that I have included such authority elsewhere in this document.
My Agent is entitled to reasonable compensation for services rendered as my Agent.
My Agent will be 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 subscribed my name and affixed my seal at the City of _________ in the State of Connecticut, on this _____ day of ____________________, 20____.
SIGNED, SEAL, AND DELIVERED in the presence of:
______________________________ Witness Signature | ______________________________ Witness Signature |
| |
Witness Name: | Witness Name: |
______________________________ | ______________________________ |
Address: | Address: |
______________________________ | ______________________________ |
______________________________ | ______________________________ |
| |
___________________________________ | _______________ |
_________ | Date |
| |
Address: _________
Telephone Number: _________
Email Address: _________
___________________________________ | _______________ |
_________ | Date |
State of Connecticut
_________ County
On this the ____ day of ______________, 20____, before me, ______________________________, signer of the foregoing instrument, personally appeared, and acknowledged the execution of such instrument to be his/her free act and deed.
By: ______________________________
_________
______________________________
(Seal, if any)
Signature of Notary: __________________________________
My commission expires: _______________________________
IMPORTANT INFORMATION FOR AGENT
Agent's Duties
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 upon you legal duties that continue until you resign or the power of attorney is terminated or revoked. You must:
(1) Do what you know the principal reasonably expects you to do with the principal's property or, if you do not know the principal's expectations, act in the principal's best interest;
(2) Act in good faith;
(3) Do nothing beyond the authority granted in this power of attorney; and
(4) Disclose your identity as an agent whenever you act for the principal by writing or printing the name of the principal and signing your own name as "agent" in the following manner:
________________________________________________________________________
(Principal's Name) by (Your Signature) as Agent
Unless the Special Instructions in this power of attorney state otherwise, you must also:
(1) Act loyally for the principal's benefit;
(2) Avoid conflicts that would impair your ability to act in the principal's best interest;
(3) Act with care, competence, and diligence;
(4) Keep a record of all receipts, disbursements, and transactions made on behalf of the principal;
(5) Cooperate with any person that has authority to make health-care decisions for the principal to do what you know the principal reasonably expects or, if you do not know the principal's expectations, to act in the principal's best interest; and
(6) Attempt to preserve the principal's estate plan if you know the plan and preserving the plan is consistent with the principal's best interest.
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.
The meaning of the authority granted to you is defined in the Connecticut Uniform Power of Attorney Act, sections 1-350 to 1-353b, inclusive. If you violate the Connecticut Uniform Power of Attorney Act, sections 1-350 to 1-353b, inclusive, 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.