Power of Attorney - Online Template Form - Word and PDF Pro · US-law

DURABLE POWER OF ATTORNEY

State of ________

EFFECTIVE DATE: ________

IMPORTANT INFORMATION FOR THE PRINCIPAL. This Power of Attorney authorizes another person (your Agent) to make decisions concerning your property and finances for you. This Power of Attorney does not authorize the Agent to make health-care decisions for you.

Your Agent will be able to act for you without advance notice to you or your approval. The meaning of the authority granted to your Agent is determined by the Uniform Power of Attorney Act as enacted in your state and other applicable law. The authority granted by this Power of Attorney is broad and sweeping.

Unless you direct otherwise in the Special Instructions, the authority of your Agent generally continues until you die, you revoke this Power of Attorney, your Agent resigns or is unable to act for you, or, if applicable, a court terminates the appointment.

Your Agent is entitled to reasonable compensation and reimbursement of reasonable expenses actually incurred on your behalf unless you state otherwise in this document.

This form provides for the appointment of a single Agent. If you wish to appoint co-agents to act together, you may do so in the Special Instructions portion of this form. If your Agent is unable or unwilling to act and you have not named a successor agent, this Power of Attorney will terminate.

This Power of Attorney is durable. It shall not be affected by the subsequent disability, incapacity, or incompetency of the Principal, and shall become effective on the Effective Date listed above unless you state otherwise in the Special Instructions portion of this form.

If you have questions about this Power of Attorney or the authority you are granting, you should seek the advice of independent legal counsel before signing.

§ 1. DESIGNATION OF AGENT. I, ________, residing at ________ (the “Principal”), name the following person as my attorney-in-fact, hereinafter referred to as my “Agent,” under this Durable Power of Attorney: ________. The Agent’s address and telephone number, as I am currently aware of them, are as follows:

________

My Agent shall be compensated, and reimbursed for reasonable expenses, as follows:

________

§ 2. DESIGNATION OF SUCCESSOR AGENT(S). If my Agent is unable or unwilling to act for me, I name the following individual as my successor agent: ________. The successor agent shall act as my sole and exclusive agent only in the event my original Agent is unable or unwilling to act, and the two shall not act together. The successor agent’s address and telephone number, as I am currently aware of them, are as follows:

________

If the foregoing successor agent is also unable or unwilling to act, I name the following second successor agent: ________, whose address and telephone number are: ________.

§ 3. GRANT OF GENERAL AUTHORITY. I grant my Agent and any successor agent general authority to act for me, with full power and authority, with respect to the following subjects, as those subjects are defined and described under the Uniform Power of Attorney Act as enacted in my home state. I have initialed below each subject for which I grant authority (subjects not initialed are excluded):

______ (Initials) a) Real Property;

______ (Initials) b) Tangible Personal Property;

______ (Initials) c) Stocks and Bonds;

______ (Initials) d) Commodities and Options;

______ (Initials) e) Banks and Other Financial Institutions;

______ (Initials) f) Operation of Entity or Business;

______ (Initials) g) Insurance and Annuities;

______ (Initials) h) Estates, Trusts, and Other Beneficial Interests;

______ (Initials) i) Claims and Litigation;

______ (Initials) j) Personal and Family Maintenance;

______ (Initials) k) Benefits from Governmental Programs or Civil or Military Service;

______ (Initials) l) Retirement Plans;

______ (Initials) m) Taxes;

______ (Initials) n) Records, Reports, and Statements.

My Agent shall have the authority to do, on my behalf, all acts reasonably necessary to exercise the authority granted in this section, as provided under the Uniform Power of Attorney Act as enacted in my home state.

§ 4. GRANT OF SPECIFIC AUTHORITY. My Agent may exercise the following specific authority only if I have initialed the corresponding line. I understand and acknowledge that these specific acts could significantly affect my property and estate plan, change how my property is managed or distributed, or reduce my property. (Initials are required next to each act you wish to grant.)

______ (Initials of Principal) a) Create, amend, or revoke a beneficiary designation;

______ (Initials of Principal) b) Create, amend, modify, revoke, or terminate an inter vivos trust;

______ (Initials of Principal) c) Create or change rights of survivorship;

______ (Initials of Principal) d) Delegate authority granted under this Power of Attorney;

______ (Initials of Principal) e) Exercise fiduciary powers that I have authority to delegate;

______ (Initials of Principal) f) Waive my right to be a beneficiary of a joint and survivor annuity, including a survivor benefit under a retirement plan;

______ (Initials of Principal) g) Revoke a transfer-on-death deed;

______ (Initials of Principal) h) Adjust or modify my financial accounts;

______ (Initials of Principal) i) Make a gift, subject to the limitations of applicable law in my home state of ________.

§ 5. LIMITATIONS ON AGENT’S AUTHORITY. Except to the extent the authority to make gifts is specifically granted in § 4 above and exercised consistent with any Special Instructions:

a) Notwithstanding any other provision of this document, any authority granted to my Agent shall be limited so as to prevent this Power of Attorney from causing (i) my Agent to be taxed on my income, or (ii) my assets to be subject to a “general power of appointment” held by my Agent within the meaning of 26 U.S.C. § 2041 and 26 U.S.C. § 2514 of the Internal Revenue Code of 1986, as amended;

b) My Agent shall have no power or authority with respect to any trust of which I am a trustee, and shall have no power or authority with respect to any insurance policy I may own on the life of my Agent; and

c) An Agent who is not my spouse, descendant, ancestor, or other close relative shall not use my property, real or personal, or any financial instrument or interest belonging to me, to benefit the Agent or a person to whom the Agent owes an obligation of support, unless I have expressly granted that authority in the Special Instructions below.

§ 6. SPECIAL INSTRUCTIONS. The following Special Instructions limit or modify the authority granted in this Power of Attorney (including, if desired, the appointment of co-agents, modifications to the Effective Date, gift limitations, or any other directions):

________

§ 7. NOMINATION OF CONSERVATOR / GUARDIAN. If it becomes necessary for a court to appoint a conservator of my estate or a guardian of my person, I nominate the following person for appointment:

Name of Nominee: ________

Nominee’s Address & Telephone:

________

§ 8. RELIANCE BY AGENT AND THIRD PARTIES. My Agent and any successor agent may rely upon the validity of this Power of Attorney until each receives actual knowledge of its revocation or termination. I agree to indemnify any third party for claims that arise against the third party because of reliance on this Power of Attorney.

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§ 10. REVOCATION. I, the Principal, may revoke all or any part of the authority granted in this Power of Attorney at any time. Such revocation shall be effective in accordance with applicable law. This Power of Attorney revokes all prior powers of attorney concerning my property and finances, except as I may state in the Special Instructions.

§ 11. GOVERNING LAW. The law of the State of ________ shall govern this Power of Attorney in all respects, including its meaning and effect, except to the extent that another applicable law controls. This Power of Attorney is intended to be governed by the Uniform Power of Attorney Act as enacted in that state.

§ 12. SEVERABILITY. If any provision of this Power of Attorney is held to be invalid or unenforceable, the remaining provisions shall continue in full force and effect.

§ 13. HEALTH CARE. This Power of Attorney does not authorize my Agent to make any health-care decisions for me. Such powers, if granted, are contained in a separate advance health-care directive governed by other applicable law. I have ________ executed an advance health-care directive.

IMPORTANT INFORMATION FOR AGENT

By accepting or acting under the appointment, you assume the fiduciary and other legal responsibilities of an agent. A special legal relationship is created between you and the Principal that continues until you resign or the Power of Attorney is terminated or revoked.

Your duties include, but are not limited to:

a) Acting in accordance with the Principal’s reasonable expectations to the extent actually known and, otherwise, in the Principal’s best interest with respect to the property described herein;

b) Acting only within the scope of authority granted in this Power of Attorney;

c) Acting loyally for the Principal’s benefit;

d) Avoiding conflicts of interest that would impair your ability to act in the Principal’s best interest;

e) Acting with the care, competence, and diligence ordinarily exercised by agents in similar circumstances;

f) Keeping a record of all receipts, disbursements, and transactions made on behalf of the Principal;

g) Keeping the Principal’s property and money separate from your own, unless already commingled or unless the Principal has directed otherwise;

h) Cooperating with any person who has authority to make health-care decisions for the Principal, to the extent consistent with the Principal’s reasonable expectations or best interest;

i) Acting in good faith; and

j) Disclosing your agency relationship whenever you sign or execute a document on the Principal’s behalf, for example by signing the Principal’s name, followed by your name and signature, with the notation “as Agent.”

§ 14. TERMINATION OF AGENT’S AUTHORITY. Upon becoming aware of any event that terminates this Power of Attorney or your authority under it, you must immediately cease acting as Agent. Such events include:

a) The Principal’s revocation of this document or of your authority;

b) The occurrence of any termination event stated in this document;

c) The complete accomplishment of the purposes of this Power of Attorney;

d) The death of the Principal;

e) The appointment and qualification of a guardian or conservator, where required by law, or the suspension of your authority by court order; or

f) If you are married to the Principal, the filing of an action for the annulment, dissolution, or legal separation of your marriage, unless this document provides otherwise.

If there is anything about this document or your duties that you do not understand, you should seek independent legal counsel.

§ 15. LIABILITY OF AGENT. This Power of Attorney and your duties as Agent are governed by the Uniform Power of Attorney Act as enacted in the State of ________. An Agent who violates that Act, breaches a fiduciary duty, or acts outside the authority granted in this document may be liable for the resulting damages, restoration of the value of the Principal’s property, and reasonable attorney’s fees and costs.

EXECUTION BY PRINCIPAL

I, ________, the Principal, sign my name to this Power of Attorney on the date set forth below and, being first duly sworn, declare to the undersigned authority that I sign and execute this instrument as my Power of Attorney, that I sign it willingly (or willingly direct another to sign for me), that I execute it as my free and voluntary act for the purposes expressed in this Power of Attorney, and that I am eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence.

Name of Principal: ________

_____________________________

Signature of Principal

_____________________________

Date

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_____________________________

Signature of Witness One — Printed Name: ________

Address: ________

_____________________________

Signature of Witness Two — Printed Name: ________

Address: ________

ACKNOWLEDGMENT OF NOTARY PUBLIC

State of ________

County of ________

On this ________ day of ________, 20____, before me, the undersigned notary public, personally appeared ________, who is personally known to me or who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the foregoing instrument, and who acknowledged to me that he or she executed the same as his or her free act and deed for the purposes therein expressed.

Witness my hand and official seal.

__________________________________________________________________

Notary Public Signature

Printed Name: ________

My Commission Expires: ________

Commission / Notary Number: ________

ACCEPTANCE OF APPOINTMENT BY AGENT

I, ________, have read and understand the foregoing Power of Attorney and the duties of an Agent set forth herein. I accept appointment as Agent and agree to act in accordance with those duties and applicable law.

_____________________________

Signature of Agent

Date: ________