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 by executing this Power of Attorney, you should provide written notice of the revocation to your prior agent(s) and to 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.senate.state.ny.us or www.assembly.state.ny.us.
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.
THIS Power of Attorney is given by me, _______________ (the "Principal"), presently of _______________, _______________, in the State of New York, on this _________ day of _____________, 20___.
Previous Power of Attorney
- I REVOKE any previous Power of Attorney granted by me.
Agent
- I APPOINT __________________, of ___________________________, __________________, New York, to act as my Agent.
Governing Law
- This document will be governed by the laws of the State of New York. Further, my Agent is directed to act in accordance with the laws of the State of New York at any time he or she may be acting on my behalf.
Liability of Agent
- My Agent will not be liable to me, my estate, my heirs, successors or assigns for any action taken or not taken under this document, except for willful misconduct or gross negligence.
Effective Date
- This Power of Attorney will start immediately and will cease to be in effect upon a finding of my mental incapacity or mental infirmity which may occur after my execution of this Power of Attorney.
Powers of Agent
- My Agent has authority to do anything on my behalf that I may lawfully do by an Agent (the "General Power").
Specific Powers
- Without restricting its generality in any way, the following power(s) are specifically included within the foregoing General Power:
Initial the line at each authority you grant
X_____Real Estate Transactions
To deal with any interest I may have in real property and sign all documents on my behalf concerning my interest, including, but not limited to, real property I may subsequently acquire or receive. These powers include, but are not limited to, the ability to:
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Purchase, sell, exchange, accept as gift, place as security on loans, convey with or without covenants, rent, collect rent, sue for and receive rents, eject and remove tenants or other persons, to pay or contest taxes or assessments, control any legal claim in favor of or against me, partition or consent to partitioning, mortgage, charge, lease, surrender, manage or otherwise deal with real estate and any interest therein; and
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ii.
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Execute and deliver deeds, transfers, mortgages, charges, leases, assignments, surrenders, releases and other instruments required for any such purpose.
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X_____Maintain Property and Make Investments
To retain any assets owned by me at the date this Ordinary Power of Attorney becomes effective, and the power to reinvest those assets in similar investments. In addition, my Agent may invest my assets in any new investments, of his or her choosing, regardless of whether or not they are authorized by any applicable legislation.
X_____Banking Transactions
To do any act that I can do through an Agent with a bank or other financial institution. This power includes, but is not limited to, the power to:
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Open, maintain or close bank accounts (including, but not limited to, checking accounts, savings accounts, and certificates of deposit), brokerage accounts, retirement plan accounts, and other similar accounts with financial institutions;
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ii.
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Conduct any business with any banking or financial institution with respect to any of my accounts, including, but not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other instruments with respect to any such accounts, obtaining bank statements, passbooks, drafts, money orders, warrants, and certificates or vouchers payable to me by any person, firm, corporation or political entity;
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iii.
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Borrow money from any banking or financial institution if deemed necessary by my Agent, and to manage all aspects of the loan process, including the placement of security and the negotiation of terms;
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iv.
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Perform any act necessary to deposit, negotiate, sell or transfer any note, security, or draft of the United States of America, including U.S. Treasury Securities;
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v.
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Have access to any safe deposit box that I might own, including its contents; and
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vi.
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Create and deliver any financial statements necessary to or from any bank or financial institution.
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X_____Business Operating Transactions
To take any action my Agent deems necessary with any business that I may own or have an interest in by doing any act which can be done through an Agent. This power includes, but is not limited to, the power to execute, seal and deliver any instrument; participate in any legal business of any kind; execute partnership agreements and amendments; to incorporate, reorganize, consolidate, merge, sell, or dissolve any business; to elect or employ officers, directors and agents; and to exercise voting rights with respect to any stock I may own, either in person or by proxy.
X_____Insurance Transactions
To do any act that I can do through an Agent with any insurance policy. This power includes, but is not limited to, the power to pay premiums, start, modify or terminate policies, manage all cash payouts, borrow from insurers and third parties using insurance policies as collateral, and to change the beneficiaries on any insurance policies on my life. Unless my Agent was already a beneficiary of any policy before the signing of this document, my Agent cannot name himself or herself as a beneficiary of such policy.
X_____Claims and Litigation Matters
To institute, maintain, defend, compromise, arbitrate or otherwise dispose of, any and all actions, suits, attachments or other legal proceedings for or against me. This power includes, but is not limited to, the power to: appear on my behalf, and the power to settle any claim against me in whichever forum or manner my Agent deems prudent, and to receive or pay any resulting settlement.
X_____Tax Matters
To act for me in all matters that affect my local, state and federal taxes and to prepare, sign, and file documents with any governmental body or agency, including, but not limited to, authority to:
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Prepare, sign and file income and other tax returns with federal, state, local and other governmental bodies, and to receive any refund checks; and
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ii.
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Obtain information or documents from any government or its agencies, and represent me in all tax matters, including the authority to negotiate, compromise, or settle any matter with such government or agency.
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X_____Government Benefits
To act on my behalf in all matters that affect my right to allowances, compensation and reimbursements properly payable to me by the Government of the United States or any agency or department thereof. This power includes, but is not limited to, the power to prepare, file, claim, defend or settle any claim on my behalf and to receive and manage, as my Agent sees fit, any proceeds of any claim.
X_____Retirement Benefit Transactions
To act for me and represent my interests in all matters affecting any retirement savings or pension plans I may have. This power includes, but is not limited to, the power to continue contributions, change contribution amounts, change investment strategies and options, move assets to other plans, receive and manage payouts, and add or change existing beneficiaries. My Agent cannot add himself or herself as a beneficiary unless he or she is already a designated beneficiary as of the signing of this document.
X_____Family Care
To make whatever expenditures are required for the maintenance, education, benefit, medical care and general advancement of me, my spouse and dependent children, and other persons that I have chosen or which I am legally required to support, any of which may include my Agent. This power includes, but is not limited to, the power to pay for housing, clothing, food, travel and other living costs.
X_____Chattel and Goods Transactions
To purchase, sell or otherwise deal with any type of personal property I may currently or in the future have an interest in. This includes, but is not limited to, the power to purchase, sell, exchange, accept as gift, place as security on loans, rent, lease, to pay or contest taxes or assessments, mortgage or pledge.
X_____Estate Transactions
To do any act that I can do through an Agent with regard to all matters that affect any trust, probate estate, conservatorship, or other fund from which I may receive payment as a beneficiary. This power includes the power to disclaim any interest which might otherwise be transferred or distributed to me from any other person, estate, trust, or other entity, as may be appropriate. However, my Agent cannot disclaim assets to which I would be entitled, if the result is that the disclaimed assets pass directly or indirectly to my Agent or my Agent's estate.
X_____Living Trust Transactions
To transfer any of my assets to the trustee of any revocable trust created by me, if such trust is in existence at the time of such transfer. This property can include real property, stocks, bonds, accounts, insurance policies or other property.
X_____Gift Transactions
To make gifts to my spouse, children, grandchildren, great grandchildren, and other family members on special occasions, including birthdays and seasonal holidays, including cash gifts, and to such other persons with whom I have an established pattern of giving (or if it is appropriate to make such gifts for estate planning and/or tax purposes), in such amounts as my Agent may decide in his or her absolute discretion, having regard to all of the circumstances, including the gifts I made while I was capable of managing my own estate, the size of my estate and my income requirements.
X_____Employ Required Professionals
To appoint and employ any agents, servants, companions, or other persons, including nurses and other health care professionals for my care and the care of my spouse and dependent children, and accountants, attorneys, clerks, workers and others for the management, preservation and protection of my property and estate, at such compensation and for such length of time as my Agent considers advisable.
X_____Manage Real Estate
To manage the property owned by me, or in which I have an interest, located at _____________________________________________________, and municipally known as _____________________________________________________. This power includes, but is not limited to, the power to receive rents, make repairs, pay expenses including the insuring of the property and generally to deal with my property as effectually as I myself could do; to take all lawful proceedings by way of action or otherwise, for recovery of rent in arrears, or for eviction of tenants; and to commence, carry on and defend all actions, suits and other proceedings touching my property or any part of it.
X_____Manage Specific Financial Account
To control my accounts with ____________________ Bank, located at _________________________________________, Account Number(s)__________________________________________. This power includes the authority to conduct any business with respect to any of my listed accounts, including, but not limited to, making deposits and withdrawals, negotiating or endorsing any cheques or other instruments with respect to any such accounts, obtaining bank statements, passbooks, drafts, money orders, warrants, and certificates or vouchers payable to me by any person, firm, corporation or political entity, and to perform any act necessary to deposit, negotiate, sell or transfer any note, security or draft.
Agent Compensation
- My Agent will receive no compensation except for the reimbursement of all out of pocket expenses associated with the carrying out of my wishes.
Co-owning of Assets and Mixing of Funds
- My Agent may not mix any funds owned by him or her in with my funds and all assets should remain separately owned if at all possible.
Personal Gain from Managing My Affairs
- My Agent is not allowed to personally gain from any transaction he or she may complete on my behalf.
Delegation of Authority
- My Agent may not delegate any authority granted under this document.
Agent Restrictions
- This Power of Attorney is not subject to any conditions or restrictions other than those noted above.
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.
Termination
- 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.
Severability
- If any part of any provision of this document is ruled invalid or unenforceable under applicable law, such part will be ineffective to the extent of such invalidity only, without in any way affecting the remaining parts of such provisions or the remaining provisions of this document.
Acknowledgment
- I, _______________, being the Principal named in this Power of Attorney hereby acknowledge:
- I have read and understand the nature and effect of this Power of Attorney;
- I am of legal age in the State of New York to grant a Power of Attorney; and
- I am voluntarily giving this Power of Attorney.
IN WITNESS WHEREOF
I hereunto set my hand and seal at the City of ________________ in the State of New York, this _________ day of _____________, 20___.
SIGNED, SEALED, AND DELIVERED
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in the presence of:
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Witness: ______________________ (Sign)
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Witness Name: ______________________
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Address: ___________________________
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__________________________________
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___________________________________
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_______________ (Principal)
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Witness: ______________________ (Sign)
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Witness Name: ______________________
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Address: ___________________________
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___________________________________
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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 manner:
(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 give major gifts to yourself or anyone else unless the principal has specifically granted you that authority in this Power of Attorney or in a Statutory Major Gifts Rider that has been attached to this 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:
It is not required that the principal and the agent(s) sign at the same time, nor that multiple agents sign at the same time.
We, __________________, have read the foregoing Power of Attorney. We are the persons identified therein as agents for the principal named therein.
We acknowledge our legal responsibilities.
______________________________________
__________________
NOTARY ACKNOWLEDGMENT
STATE OF NEW YORK
COUNTY OF ____________________
On this _________ day of _____________, 20___, before me, the undersigned, a Notary Public in and for said state, personally appeared __________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individuals whose names are subscribed to the within instrument and acknowledged to me that they executed the same in their capacities, and that by their signatures on the instrument, the individuals, or the person upon behalf of which the individuals acted, executed the instrument.
________________________________
Notary Public
My commission expires: _____________
WITNESS CERTIFICATE
I, _________________________, currently residing at __________________________, in the City of __________________, in the State of ____________________, hereby acknowledge that:
- I witnessed the signing of the Power of Attorney of _______________ dated this _________ day of _____________, 20___.
- I am an adult with capacity to witness the signing of the Power of Attorney and I am the subscribing witness thereto.
- In my opinion, _______________ had the capacity to understand the nature and effect of the Power of Attorney at the time the Power of Attorney was signed and the Principal signed it freely and voluntarily without any compulsion or influence from any person.
- I am not the Agent named in the Power of Attorney nor am I the Agent's spouse or other family member.
_________________________
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_________________________
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(Signature of Witness)
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(Date)
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WITNESS CERTIFICATE
I, _________________________, currently residing at __________________________, in the City of __________________, in the State of ____________________, hereby acknowledge that:
- I witnessed the signing of the Power of Attorney of _______________ dated this _________ day of _____________, 20___.
- I am an adult with capacity to witness the signing of the Power of Attorney and I am the subscribing witness thereto.
- In my opinion, _______________ had the capacity to understand the nature and effect of the Power of Attorney at the time the Power of Attorney was signed and the Principal signed it freely and voluntarily without any compulsion or influence from any person.
- I am not the Agent named in the Power of Attorney nor am I the Agent's spouse or other family member.
_________________________
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_________________________
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(Signature of Witness)
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(Date)
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