STATUTORY FORM POWER OF ATTORNEY
THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS:
Notice to the Principal: As the "Principal", you are using this Power of Attorney to grant power to another person (called the "Agent") to make decisions, including, but not limited to, decisions concerning your money, property, or both, and to use your money, property, or both on your behalf.
If this Power of Attorney does not limit the powers that you give to your Agent, your Agent will have broad and sweeping powers to sell or otherwise dispose of your property, and to spend your money without advance notice to you or approval by you.
Unless you have expressly provided otherwise in this Power of Attorney, your Agent will have these powers before you become incapacitated, and unless you have expressly provided otherwise in this Power of Attorney, your Agent will continue to have these powers after you become incapacitated.
You have the right to retain this Power of Attorney and to release it later, or to request that another person retain this Power of Attorney on your behalf and release it only if one or more conditions specified in advance by you are satisfied. You have the right to revoke or take back this Power of Attorney at any time, so long as you are of sound mind.
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.
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Principal's Signature
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Date
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
(Initial beside your choice of A or B, but not both.)
________ - A. I grant my agent and any successor agent general authority to act for me in all matters, including, without limitation, all the subjects enumerated in B below.
________ - B. I grant my agent and any successor agent general authority over the following subjects as defined in the following sections of the Uniform Power of Attorney Act:
(Initial each subject you want to include in the agent's general authority.)
________ - Real property as defined in RSA 564-E:204.
________ - Tangible personal property as defined in RSA 564-E:205.
________ - Stocks and bonds as defined in RSA 564-E:206.
________ - Commodities and options as defined in RSA 564-E:207.
________ - Banks and other financial institutions as defined in RSA 564-E:208.
________ - Operation of entity or business as defined in RSA 564-E:209.
________ - Insurance and annuities as defined in RSA 564-E:210.
________ - Estates, Trusts, and Other Beneficial Interests as defined in RSA 564-E:211.
________ - Claims and Litigation as defined in RSA 564-E:212.
________ - Personal and Family Maintenance as defined in RSA 564-E:213.
________ - Benefits from governmental programs or civil or military service as defined in RSA 564-E:214.
________ - Retirement plans as defined in RSA 564-E:215.
________ - Taxes as defined in RSA 564-E:216.
________ - Digital assets, subject to the limitations of the New Hampshire Revised Uniform Fiduciary Access to Digital Assets Act.
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.
This Power of Attorney shall be governed by the laws of the State of New Hampshire.
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.
Dated ____________________, _____, at _________, New Hampshire.
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_________ | Date |
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Address: _________
Telephone Number: _________
Email Address: _________
___________________________________ | _______________ |
_________ | Date |
State of New Hampshire
_________ County
This document was acknowledged before me on | _______________. |
| (date) |
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, 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 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.
You will have no authority to act as an agent under this Power of Attorney until you sign and affix this acknowledgment to the Power of Attorney.
I, _________, have read the attached power of attorney and I am the person(s) identified as the agent(s) for the principal. I hereby acknowledge that when I act as an agent I am given power under the power of attorney to make decisions about money, property, or both belonging to the principal, and to spend the principal's money, property, or both on the principal's behalf, in accordance with the terms of the power of attorney. When acting as an agent, I have duties (called "fiduciary duties") to act in the principal's best interest, to act in good faith, and to act only within the scope of authority granted in the power of attorney, as well as other duties imposed by law to the extent not provided otherwise in the power of attorney. As an agent, I am not entitled to use the money or property for my own benefit or to make gifts to myself or others unless the power of attorney specifically gives me the authority to do so. As an agent, my authority under the power of attorney will end when the principal dies, and I will not have the authority to manage or dispose of any property or administer the estate of the principal. If I violate a fiduciary duty under the power of attorney, I may be liable for damages and may be subject to criminal prosecution. If there is anything about this power of attorney, or my duties under it, that I do not understand, I understand that I should seek professional advice.
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_________'s Signature | Date |
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Agent's Name Printed
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Agent's Address