The use of the following form, or one which substantially conforms to the following form, in the creation of a power of attorney is lawful, and, when used, and executed in accordance with subdivision one of section 5-1501 B of this title, it shall be construed as a statutory short form power of attorney in accordance with the provisions of this title; provided however, that any section indicated as "Optional" which is not used may be omitted and replaced by the words "Intentionally Omitted":
"POWER OF ATTORNEY
NEW YORK STATUTORY SHORT FORM
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, you should provide written notice of the revocation to your prior agent(s) and to any third parties who may have acted upon it, including 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.nysenate.gov or www.nyassembly.gov.
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.
I, _______________________________________________, hereby appoint: name and address of principal
_____________________________________________________as my agent(s) name(s) and address(es) of agent(s)
If you designate more than one agent above and you do not initial the statement below, they must act together.
If any agent designated above is unable or unwilling to serve, I appoint as my successor agent(s):
_______________________________________________________________
name(s) and address(es) of successor agent(s)
If you do not initial the statement below, successor agents designated above must act together.
You may provide for specific succession rules in this section. Insert specific succession provisions here:
To grant your agent some or all of the authority below, either
I grant authority to my agent(s) with respect to the following subjects as defined in sections 5-1502 A through 5-1502N of the New
York General Obligations Law:
You need not initial the other lines if you initial line (P).
In order to authorize your agent to make gifts in excess of an annual total of $5,000 for all gifts described in (I) of the grant of authority section of this document (under personal and family maintenance), and/or to make changes to interest in your property, you must expressly grant that authorization in the Modifications section below. If you wish to authorize your agent to make gifts to himself or herself, you must expressly grant such authorization in the Modifications section below.
Granting such authority to your agent gives your agent the authority to take actions which could significantly reduce your property and/or change how your property is distributed at your death. Your choice to grant such authority should be discussed with a lawyer.
In this section, you may make additional provisions, including, but not limited to, language to limit or supplement authority granted to your agent, language to grant your agent the specific authority to make gifts to himself or herself, and/or language to grant your agent the specific authority to make other gift transactions and/or changes to interests in your property. Your agent is entitled to be reimbursed from your assets for reasonable expenses incurred on your behalf. In this section, you may make additional provisions if you ALSO wish your agent(s) to be compensated from your assets for services rendered on your behalf, and you may define "reasonable compensation."
If you wish to appoint monitor(s), initial and fill in the section below:
Your agent is entitled to be reimbursed from your assets for reasonable expenses incurred on your behalf. If you ALSO wish your agent(s) to be compensated from your assets for services rendered on your behalf, and/or you wish to define "reasonable compensation", you may do so above, under "Modifications".
Section 5-1511 of the General Obligations Law describes the manner in which you may revoke your Power of Attorney, and the events which terminate the Power of Attorney.
PRINCIPAL signs here: ==__________________________________________ (acknowledgment)
By signing as a witness, I acknowledge that the principal signed the Power of Attorney in my presence and in the presence of the other witness, or that the principal acknowledged to me that the principal's signature was affixed by him or her or at his or her direction. I also acknowledge that the principal has stated that this Power of Attorney reflects his or her wishes and that he or she has signed it voluntarily. I am not named herein as an agent or as a permissible recipient of gifts.
_____________________________________________________________
_____________________________ | ________________________________ |
Signature of Witness 1 | Signature of Witness 2 |
_______________________________ | _____________________________ |
Date | Date |
_______________________________ | _____________________________ |
Print name | Print name |
_______________________________ | _____________________________ |
Address | Address |
_______________________________ | _____________________________ |
City, State, Zip Code | City, State, Zip Code |
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:
You may not use the principal's assets to benefit yourself or anyone else or make gifts to yourself or anyone else unless the principal has specifically granted you that authority in the modifications section of this document or a Non-Statutory 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.
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.
I/we, ___________________________________________, have read the foregoing Power of Attorney. I am/we are the person(s) identified therein as agent(s) for the principal named therein.
I/we acknowledge my/our legal responsibilities.
In Witness Whereof I have hereunto signed my name on ________________20_____.
Agent(s) sign(s) here:==__________________________________________
(acknowledgment(s))
It is not required that the principal and the SUCCESSOR agent(s), if any, sign at the same time, nor that multiple SUCCESSOR agents sign at the same time. Furthermore, successor agents can not use this power of attorney unless the agent(s) designated above is/are unable or unwilling to serve.
I/we, ___________________________________________, have read the foregoing Power of Attorney. I am/we are the person(s) identified therein as
SUCCESSOR agent(s) for the principal named therein.
In Witness Whereof I have hereunto signed my name on ________________20_____.
Successor Agent(s) sign(s) here:==______________________________________
(acknowledgment(s))"
N.Y. Gen. Oblig. Law § 5-1513