Professional Documents
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R POWER OF ATTO
(a) CAUTION TO THE PRINCIPAL: YOUR
TTORNEY
CIPA
YOU GIVE THE
IS AN IMPORTANT DOCUMENT. AS THE PRINCIPAL
PERSON WHOM YOU CHOOSE (YOUR AGENT
GENT AUTHORITY TO SPE
SP
SPEND
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GOV
THE LAW GOVERNING
POW
OWERS OF ATTORNEY IS CONTAINED IN THE
NEW YORK GENERA
ENERAL OBLIGATIONS LAW, ARTICLE 5, TITLE 15.
THIS
IS LAW IS AVAILABLE
AV
AT A LAW LIBRARY, OR ONLINE THROUGH
EW YORK STATE SENATE OR ASSEMBLY WEBSITES,
THE NE
WWW.SENATE. STATE.NY.US OR WWW.ASSEMBLY.STATE.NY.US.
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ncipal]
[name of principal]
[address of principal]
hereby appoint:
[name of agent]
[nam
[address of agent]
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as my agent(s).
ent(s).
Iff you designate more than one agent above, they must act together
nless you init
unless
stateme below.
initial the statement
____) My agents
age may act SEPARATELY.
(______)
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nd successor agent]
[name
name of second
a
[name of third successor agent]
[address of second su
successor agent]
Successor agents designated above must act together unless you initial
below.
the statement
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Iff you do NO
NOT intend to revoke your prior Powers of Attorney, and if
you
u hhave granted the same authority in this Power of Attorney as you
granted
another agent in a prior Power of Attorney, each agent can act
ted to an
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the same authority are to act together.
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I grant authority
subjects as
follo
ority to my agent(s) with respect to the following
subj
defined
General
ed in sections 5-1502A through 5-1502N of the New York
Y
ns Law:
Obligations
S
(______)
(______)
(______)
(______)
(
(______)
(______)
((______)
(______)
(______)
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
trans
real estate transactions;
transactions;
chattel an
and goods tr
bo
bond, share aand commodity transactions;
banking transactions;
bankin
business
operating transactions;
b
insurance transactions;
estate transactions;
claims and litigation;
personal and family maintenance. If you grant
nt yyour
agent this authority, it will allow the agentt to make gifts
gi
that you customarily have made to individuals,
including
dividuals, includin
ndividuals,
your agent, and charitable organizations.
zations. The total
amount of all such gifts in any one calendar
endar year cannot
exceed $500;
(______) (J) benefits from
al programs or civil or military
m governmental
service;
ce;
(______) (K) health caree billing and payment matters; records, rep
reports
ements
and statements;
(______)
transactions;
_____) (L) retirement benefit transaction
(______) (M) tax matters;
(______) (N) all other matters
matters;
(______) (O) full and unq
unqualified aauthority to my agent(s) to delegate
ny or all of the
any
po
foregoing powers
to any person or persons whom my agent(s) select;
(______)
of the matters identified by the following letters
_____)) (P) EACH
EA
A, B, C, D, E, F, G, H, I, J, K, L, M, N and O.
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You need not initial the other lines if you initial line (P).
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(______) My agent(s)
led to reasonable compensat
s) shall be entitled
compensation for
fo
services
ces rendered.
(k)) ACCEPTANCE
TANCE BY THIRD PARTIES:
PARTIES I agree to
t indemnify the
again the
third party for any claims that may arise against
th third party because
understand that any termination
of reliance on this Power of Attorney. I und
of this Power of Attorney
Attorney, whether tthe result of my revocation of the
otherwise, is not effective as to a third party until
Power of Attorney or otherwise
or knowledge of the termination.
h actual notice
the third party has
n
TERMINATION:
This Power of Attorney continues until I revoke it
T
(l) TERMINA
by my death or other event described in section 5-1511
or it is terminated
t
of the General Obligations Law.
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==>___________________________________
PRINCIPAL signs here: ==>___________________
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COUNTY OF ___________ )
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_______________________________
__________
Notary Public
P
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When you accept the authority granted under this Power of Attorney
Attorney, a
special legal relationship is created between you andd the principal. This
Th
Thi
relationship imposes on you legal responsibilities
ties that continue until you
resign or the Power of Attorney is terminated
d. You must:
nated or revoked.
(1)
(2)
S
(3))
(4)
(5)
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<RXPD\QRWXVHWKHSULQFLSDOVDVVHWVWREHQHfit yourself
else
urself or anyone
any
or make gifts to yourself or anyone else unless the princip
principal has
specifically granted you that authority inn this document,
a
cument, which is either
ei
Statutory Gifts Rider attached to a Statutory Short Form Power
Powe of
Attorney or a Non-Statutory
ory Power of Attorney. If you have that
th
authority, you must act according to any instructions of the princ
principal or,
o
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principal and to any
t princip
u may resign by giving written notice to the
co-agent,
-agent, successor agent, monitor if one has been named in this
co
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or your
docu
is anything about this document
you responsibilities that you do not
legal advice.
understand, you shoul
should seek lega
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APPOINTMENT:
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I/we, __________________________,
___,, have read the foregoing Power of
_____________
Attorney. I am/we
we are the person(s) identified therein as agent(s) for tthe
principal named therein.
I/we acknowledge my/our legal respons
responsibilities.
Agent(s) sign(s) here: =>
=>
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COUNTY OF _________
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On the _____ day of _____, inn the year 20___, before me,
me the
th
undersigned, a Notary
appeared
perso
otary Publicc in and for said state, personally
appeare
______ ____________________,
to
_________, personally known to me or proved
__________________,
pro
me onn the basis off satisfactory evidence to be the person w
whose name is
acknowledged
to me that he/she
ackno
subscribedd to the within instrument and acknowledge
executed the same in his/her capacity, and that
tha by his/her signature on
he instrument, the person or tthe entity uupon behalf of which the person
the
instrument.
acted executed the instru
_______________________________
__________
Notary Public
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COUNTY OF _________
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_______________________________
Notary Public
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Successor Agent(s
Agent(s) sign(s) here: =>
COUNTY OF _________
=>
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_______________________________
______________
Notary
ary Public
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COUNTY OF _________
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_______________________________
__________
Notary Public
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