NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE
BROAD AND SWEEPING. IF YOU HAVE ANY QUESTIONS ABOUT THESE POWERS,
OBTAIN COMPETENT LEGAL ADVICE. THIS DOCUMENT DOES NOT AUTHORIZE
ANYONE TO MAKE MEDICAL AND OTHER HEALTH-CARE DECISIONS FOR YOU.
YOU MAY REVOKE THIS POWER OF ATTORNEY IF YOU LATER WISH TO DO
SO.
I, _____________________________ [YOUR FULL LEGAL
NAME], residing at ___________________________________ [YOUR FULL
ADDRESS], hereby appoint ___________________________________ of
_________________________, _________________________, ___________________________________,
as my Attorney-in-Fact ("Agent").
If my Agent is unable to serve for any reason, I
designate ___________________________________, of _________________________,
_________________________, _________________________ __________,
as my successor Agent.
I hereby revoke any and all general powers of attorney
that previously have been signed by me. However, the preceding
sentence shall not have the effect of revoking any powers of attorney
that are directly related to my health care that previously have
been signed by me.
My Agent shall have full power and authority to
act on my behalf. This power and authority shall authorize my
Agent to manage and conduct all of my affairs and to exercise
all of my legal rights and powers, including all rights and powers
that I may acquire in the future. My Agent's powers shall include,
but not be limited to, the power to:
1. Open, maintain or close bank accounts (including,
but not limited to, checking accounts, savings accounts, and certificates
of deposit), brokerage accounts, and other similar accounts with
financial institutions.
a. 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, obtaining bank
statements, passbooks, drafts, money orders, warrants, and certificates
or vouchers payable to me by any person, firm, corporation or
political entity.
b. 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.
c. Have access to any safe deposit box that I might
own, including its contents.
2. Sell, exchange, buy, invest, or reinvest any
assets or property owned by me. Such assets or property may include
income producing or non-income producing assets and property.
3. Purchase and/or maintain insurance, including
life insurance upon my life or the life of any other appropriate
person.
4. Take any and all legal steps necessary to collect
any amount or debt owed to me, or to settle any claim, whether
made against me or asserted on my behalf against any other person
or entity.
5. Enter into binding contracts on my behalf.
6. Exercise all stock rights on my behalf as my
proxy, including all rights with respect to stocks, bonds, debentures,
or other investments.
7. Maintain and/or operate any business that I may
own.
8. Employ professional and business assistance as
may be appropriate, including attorneys, accountants, and real
estate agents.
9. Sell, convey, lease, mortgage, manage, insure,
improve, repair, or perform any other act with respect to any
of my property (now owned or later acquired) including, but not
limited to, real estate and real estate rights (including the
right to remove tenants and to recover possession). This includes
the right to sell or encumber any homestead that I now own or
may own in the future.
10. Prepare, sign, and file documents with any governmental
body or agency, including, but not limited to, authorization to:
a. Prepare, sign and file income and other tax returns
with federal, state, local, and other governmental bodies.
b. Obtain information or documents from any government
or its agencies, and negotiate, compromise, or settle any matter
with such government or agency (including tax matters).
c. Prepare applications, provide information, and
perform any other act reasonably requested by any government or
its agencies in connection with governmental benefits (including
military and social security benefits).
11. Make gifts from my assets to members of my family
and to such other persons or charitable organizations with whom
I have an established pattern of giving. However, my Agent may
not make gifts of my property to the Agent. I appoint ___________________________________,
of _________________________, _________________________, _________________________
__________, as my substitute Agent for the sole purpose of making
gifts of my property to my Agent, as appropriate.
12. 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.
13. 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.
This Power of Attorney shall be construed broadly
as a General Power of Attorney. The listing of specific powers
is not intended to limit or restrict the general powers granted
in this Power of Attorney in any manner.
Any power or authority granted to my Agent under
this document shall be limited to the extent necessary to prevent
this Power of Attorney from causing: (i) my income to be taxable
to my Agent, (ii) my assets to be subject to a general power of
appointment by my Agent, and (iii) my Agent to have any incidents
of ownership with respect to any life insurance policies that
I may own on the life of my Agent.
My Agent shall not be liable for any loss that results
from a judgment error that was made in good faith. However, my
Agent shall be liable for willful misconduct or the failure to
act in good faith while acting under the authority of this Power
of Attorney.
I authorize my Agent to indemnify and hold harmless
any third party who accepts and acts under this document.
My Agent shall be entitled to reasonable compensation
for any services provided as my Agent. My Agent shall be entitled
to reimbursement of all reasonable expenses incurred in connection
with this Power of Attorney.
My Agent shall provide an accounting for all funds
handled and all acts performed as my Agent, if I so request or
if such a request is made by any authorized personal representative
or fiduciary acting on my behalf.
This Power of Attorney shall become effective immediately
and shall 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 shall
continue effective until my death. This Power of Attorney may
be revoked by me at any time by providing written notice to my
Agent.
Dated ____________________, 20____ at _________________________,
_________________________.
YOUR SIGNATURE:
__________________________________
YOUR PRINTED FULL LEGAL NAME:
__________________________________
WITNESS' SIGNATURE:
__________________________________
WITNESS' PRINTED FULL LEGAL NAME:
__________________________________
WITNESS' SIGNATURE:
__________________________________
WITNESS' PRINTED FULL LEGAL NAME:
__________________________________
