• Durable Power of Attorney Form

    Durable Power of Attorney Form
  • BE IT KNOWN TO ALL, that I,         , of legal age, with address at              (hereinafter known as “principal”) hereby designate       of                   as my attorney-in-fact (hereinafter known as "Agent"), to act on my behalf, in my name, stead, and for my benefit.

  • BE IT KNOWN TO ALL FURTHER, that any "GENERAL POWER OF ATTORNEY" signed by me and in effect are now hereby revoked, except for any Advance Health Care Directive or Living Will for which I have signed.

    BE IT KNOWN TO ALL FURTHER, that this Appointment does not grant authority to transfer nor convey any property to himself/herself, to his/her family without adequate consideration, nor accept a gift and appropriate such to himself/herself now owned or later acquired, unless consent is given by me or stipulated in this Durable Power of Attorney. 

    BE IT KNOWN TO ALL FURTHER, that the undersigned Agent shall not be held liable, for losses which may result from any judgment error made in good faith while performing duties or responsibilities on my behalf, unless it is done willfully or negligently. I likewise authorize my Agent to indemnify and hold harmless any third party who accepts and acts under this instrument.

    BE IT KNOWN TO ALL FURTHER, that the undersigned Agent shall have complete authority to manage and conduct all my affairs, as stated below and to exercise all of my legal rights and powers, including any and all rights and powers that I may acquire in the future regarding the categories herein.

    IN CONSIDERATION OF THE FOREGOING PREMISES, it is my desire that my Agent shall have the following powers:

  • DATE OF EFFECTIVITY
  • Date
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  • GENERAL POWERS

    1. Demand, receive, and obtain by litigation or otherwise, money or another thing of value to which the principal is, may become, or claims to be entitled, and conserve, invest, disburse, or use anything so received or obtained for the purposes intended.
    2. Contract in any manner with any person, on terms agreeable to the agent, to accomplish a purpose of a transaction and perform, rescind, cancel, terminate, reform, restate, release, or modify the contract or another contract made by or on behalf of the principal.
    3. Execute, acknowledge, seal, deliver, file, or record any instrument or communication the agent considers desirable to accomplish a purpose of a transaction, including creating at any time a schedule listing some or all of the principal's property and attaching it to the power of attorney.
    4. Initiate, participate in, submit to alternative dispute resolution, settle, oppose, or propose or accept a compromise with respect to a claim existing in favor of or against the principal or intervene in litigation relating to the claim.
    5. Seek on the principal's behalf the assistance of a court or other governmental agency to carry out an act authorized in the power of attorney.
    6. Engage, compensate, and discharge an attorney, accountant, discretionary investment manager, expert witness, or other advisor.
    7. Prepare, execute, and file a record, report, or other document to safeguard or promote the principal's interest under a statute or regulation.
    8. Communicate with any representative or employee of a government or governmental subdivision, agency, or instrumentality, on behalf of the principal.
    9. Access communications intended for, and communicate on behalf of the principal, whether by mail, electronic transmission, telephone, or other means.
    10. Do any lawful act with respect to the subject and all property related to the subject.
  • BANKING

    To open, withdraw, receive, deposit funds in any financial institution, close an account, and to receive funds by check named to Principal, or otherwise to pay for goods, services, and any other personal and business expenses, including the execution of documents with the banking institution for the Principal's benefit.

    To assign, make, draw, endorse, make guarantee, and negotiate promissory notes, checks, drafts, and other negotiable or non-negotiable instruments of Principal or payable to the principal or the principal’s order, transfer money and accept a draft drawn by any person for the principal and make payments of the draft when due.

  • LENDING OR BORROWING

    To borrow money or make loans in my name, whether in the Principal's sole capacity and benefit or jointly with others; to give promissory notes or other obligations therefor;

    To deposit as collateral or mortgage Principal's properties whether personal or real, tangible or intangible, for security or for the payment of any or all of Principal's property, or other property of whatever nature and wherever situated, held by Principal, personally or in trust for the latter's benefit.

  • SAFE-DEPOSIT BOX

    To access, take out or remove, add any or all the contents thereof, or manage the safe-deposit boxes under the control or authority of Principal or to which Principal may have access thereto, including drilling, relinquishing, or returning the said safe-deposit box.

  • REAL PROPERTY

    To perform on behalf of the Principal, acquiring, exchanging, leasing, managing and selling, conveying, partitioning, disposing, leasing or subleasing of real property or any interests therein, including setting credit arrangements; as well as executing and transferring deeds and other documentary records which the attorney-in-fact may deem necessary in connection with the subject property.

  • GOVERNMENT BENEFITS AND TAX TRANSACTIONS

    To apply for and receive any benefits by any governmental authority that the Principal may be or shall be eligible, for the benefit and on behalf of the Principal.

    To complete and sign on the Principal's behalf, any local, state, or federal tax returns, or to pay any taxes and assessments due, or receive tax credits and refunds granted or payable to the Principal.

  • PENSION AND RETIREMENT BENEFITS

    To make contributions, select payment options, roll-over of any retirement plan, and receive the pension or retirement benefits on behalf of the Principal which Principal may own, except that the above-named attorney-in-fact may not change the name of the beneficiary of said plans or accounts.

  • INSURANCE

    To purchase, pay premiums, and claim on life, health, automobile, or homeowners' insurance on behalf of the Principal, except that the attorney-in-fact may not have the power to cash in or change the beneficiary of any life insurance policy.

  • PERSONAL PROPERTY

    To perform, on behalf of Principal acquiring or purchasing, assigning, exchanging, leasing, purchasing, selling, transferring, disposing, or conveying of personal property whether tangible or intangible, which Principal may possess or own, including granting options thereof, or any interests therein, on such terms and conditions, including credit arrangements, as the attorney-in-fact shall deem proper;

    To execute, acknowledge and deliver, under seal or otherwise, any and all assignments, transfers, titles, papers, documents or instruments, or in any case manage, which attorney-in-fact shall deem necessary in connection to such property.

    To buy, sell, exchange, pledge as security, borrow, pay, renew, or extend the time of payment of debt stocks or bonds as security, or receive certificates or evidence of ownership, and other matters which may be relative and applicable to stocks and bonds on the preceding paragraphs.

    To establish, maintain, or terminate option accounts, or to buy, sell, exercise, exchange, assign, settle commodity futures contracts, or call or put options.

  • GIFTS

    To make gifts or grants, or other transfers, to make condonation or remission of indebtedness, or make donation or pledges without consideration, either outright or in trust to other persons, including bequeathing properties owned by Principal to assigns, descendants, devisees and/or beneficiaries whether testate or intestate.

  • THIRD-PARTY SERVICES

    To acquire professional services necessary for the fulfillment and completion of tasks and obligations, including, but not limited to, seeking legal advice and/or services for the benefit of the Principal.

  • DURABILITY

    This Power of Attorney shall not terminate upon the Principal's subsequent incapacity or disability, but shall remain in effect unless and until revoked by Principal in writing at a time when Principal has legal capacity required to effect such revocation.

  • STATE GOVERNING LAW

    This Power of Attorney is governed by the laws of the State of    without regard to the conflict of law and laws of other state laws.

    IN WITNESS WHEREOF, I have executed this Power of Attorney on this    day of , . 


       
          

  • WITNESSES


    We hereby declare, exclusively and individually, before the presence of the Principal, that the Principal signed and executed this instrument in the presence of each and every party herein, and that we sign this Durable Power of Attorney as witnesses.

    We hereby declare that we are disinterested parties and we are neither the attending physician or mental health provider of the Principal, owners or operators of health care facilities where the Principal is a patient, parents, siblings, descendants, or spouses of such parent, sibling, or descendant of the Principal or the Agent.

    We hereby declare that to the best of our knowledge, this instrument has been executed willingly by the Principal, free from undue influence or restraint.


       
          
       
      
      
          
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  • ACKNOWLEDGEMENT


    STATE OF    
       County, ss.

    Before me, appeared on this       day of      ,   ,         as Principal of this Durable Power of Attorney who proved to me through government issued photo identification to be the above-named person, in my presence, executed the foregoing acceptance of appointment and acknowledged that (s)he executed the same as his/her free act and deed.

       
          
    Notary Public
    My commission expires:   Pick a Date   

  • ACCEPTANCE OF APPOINTMENT


    I,      , the named Agent above, hereby accept the appointment as attorney-in-fact in accordance with the foregoing instrument.

    As the appointed Agent in this aforementioned instrument, I hereby acknowledge that I have fully read the foregoing notice and I understand all the fiduciary duties and responsibilities. I hereby manifest my acceptance by signing as Agent in accordance with the terms and conditions contained within this instrument.

       
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  • ACKNOWLEDGEMENT


    STATE OF    
       County, ss.

    Before me, appeared on this       day of      ,   ,       as Attorney-in-Fact of this Durable Power of Attorney who proved to me through government issued photo identification to be the above-named person, in my presence, executed the foregoing acceptance of appointment and acknowledged that (s)he executed the same as his/her free act and deed.

       
          
    Notary Public
    My commission expires:    Pick a Date   

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