Fillable CALIFORNIA UNIFORM STATUTORY POWER OF ATTORNEY

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CALIFORNIA UNIFORM STATUTORY POWER OF ATTORNEY

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Statutory Form Power of Attorney – OpenDocs.com
Page 1
CALIFORNIA UNIFORM STATUTORY POWER OF ATTORNEY
(California Probate Code Section 4401)
NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING. THEY ARE
EXPLAINED IN THE UNIFORM STATUTORY FORM POWER OF ATTORNEY ACT (CALIFORNIA
PROBATE CODE SECTIONS 4400-4465). 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, of ,
[Principal’s Name] [Principal’s Address]
appoint of ,
[Agent’s Name] [Agent’s Address]
as my agent (attorney-in-fact) to act for me in any lawful way with respect to the
following initialed subjects:
TO GRANT ALL OF THE FOLLOWING POWERS, INITIAL THE LINE IN FRONT OF (N) AND IGNORE
THE LINES IN FRONT OF THE OTHER POWERS. TO GRANT ONE OR MORE, BUT FEWER THAN
ALL, OF THE FOLLOWING POWERS, INITIAL THE LINE IN FRONT OF EACH POWER YOU ARE
GRANTING. TO WITHHOLD A POWER, DO NOT INITIAL THE LINE IN FRONT OF IT. YOU MAY, BUT
NEED NOT, CROSS OUT EACH POWER WITHHELD.
INITIAL
(A) Real property transactions.
(B) Tangible personal property transactions.
(C) Stock and bond transactions.
(D) Commodity and option transactions.
(E) Banking and other financial institution transactions.
(F) Business operating transactions.
(G) Insurance and annuity transactions.
(H) Estate, trust, and other beneficiary transactions.
(I) Claims and litigation.
(J) Personal and family maintenance.
(K) Benefits from social security, medicare, medicaid, or other
governmental programs, or civil or military service.
(L) Retirement plan transactions.
(M) Tax matters.
(N) ALL OF THE POWERS LISTED ABOVE.
YOU DO NOT NEED TO INITIAL ANY OTHER LINES IF YOU INITIAL LINE (N).
Statutory Form Power of Attorney – OpenDocs.com
Page 2
SPECIAL INSTRUCTIONS:
ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS LIMITING OR
EXTENDING THE POWERS GRANTED TO YOUR AGENT
UNLESS YOU DIRECT OTHERWISE ABOVE, THIS POWER OF ATTORNEY IS EFFECTIVE
IMMEDIATELY AND WILL CONTINUE UNTIL IT IS REVOKED.
This power of attorney will continue to be effective even though I become
incapacitated.
STRIKE THE PRECEDING SENTENCE IF YOU DO NOT WANT THIS POWER OF ATTORNEY TO
CONTINUE IF YOU BECOME INCAPACITATED.
EXERCISE OF POWER OF ATTORNEY WHERE MORE THAN ONE AGENT DESIGNATED
If I have designated more than one agent, the agents are to act .
IF YOU APPOINTED MORE THAN ONE AGENT AND YOU WANT EACH AGENT TO BE ABLE TO ACT
ALONE WITHOUT THE OTHER AGENT JOINING, WRITE THE WORD "SEPARATELY" IN THE BLANK
SPACE ABOVE. IF YOU DO NOT INSERT ANY WORD IN THE BLANK SPACE, OR IF YOU INSERT THE
WORD "JOINTLY", THEN ALL OF YOUR AGENTS MUST ACT OR SIGN TOGETHER.
I agree that any third party who receives a copy of this document may act
under it. Revocation of the power of attorney is not effective as to a third party
until the third party has actual knowledge of the revocation. I agree to
indemnify the third party for any claims that arise against the third party
because of reliance on this power of attorney.
Signed this day of , 20 .
[Signature of Principal]
[Principal’s Social Security Number]
BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT ASSUMES THE FIDUCIARY
AND OTHER LEGAL RESPONSIBILITIES OF AN AGENT.
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Statutory Form Power of Attorney – OpenDocs.com
Page 3
ACKNOWLEDGMENT
State of California )
) ss
County of )
On , 20 , before me, ,
a Notary Public in and for the State of California, personally appeared
, who proved to me on the basis of
satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within
instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the
instrument the person(s), or the entity upon behalf of which the person(s) acted,
executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of
California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature
My commission expires
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Page i
Statutory Form Power of Attorney – OpenDocs.com
NOTICE TO PERSON EXECUTING DURABLE POWER OF ATTORNEY
(California Probate Code Section 4128(a))
A durable power of attorney is an important legal document. By signing the durable
power of attorney, you are authorizing another person to act for you, the principal. Before
you sign this durable power of attorney, you should know these important facts:
Your agent (attorney-in-fact) has no duty to act unless you and your agent agree
otherwise in writing.
This document gives your agent the powers to manage, dispose of, sell, and
convey your real and personal property, and to use your property as security if your agent
borrows money on your behalf. This document does not give your agent the power to
accept or receive any of your property, in trust or otherwise, as a gift, unless you
specifically authorize the agent to accept or receive a gift.
Your agent will have the right to receive reasonable payment for services
provided under this durable power of attorney unless you provide otherwise in this power
of attorney.
The powers you give your agent will continue to exist for your entire lifetime, unless
you state that the durable power of attorney will last for a shorter period of time or unless
you otherwise terminate the durable power of attorney. The powers you give your agent in
this durable power of attorney will continue to exist even if you can no longer make your
own decisions respecting the management of your property.
You can amend or change this durable power of attorney only by executing a
new durable power of attorney or by executing an amendment through the same
formalities as an original. You have the right to revoke or terminate this durable power of
attorney at any time, so long as you are competent.
This durable power of attorney must be dated and must be acknowledged before a
notary public or signed by two witnesses. If it is signed by two witnesses, they must
witness either (1) the signing of the power of attorney or (2) the principal's signing or
acknowledgment of his or her signature. A durable power of attorney that may affect real
property should be acknowledged before a notary public so that it may easily be recorded.
You should read this durable power of attorney carefully. When effective, this
durable power of attorney will give your agent the right to deal with property that you now
have or might acquire in the future. The durable power of attorney is important to you. If
you do not understand the durable power of attorney, or any provision of it, then you
should obtain the assistance of an attorney or other qualified person.
[Initials of Principal]
Page ii
Statutory Form Power of Attorney – OpenDocs.com
NOTICE TO PERSON ACCEPTING THE APPOINTMENT AS ATTORNEY-IN-FACT
By acting or agreeing to act as the agent (attorney-in-fact) under this power of
attorney you assume the fiduciary and other legal responsibilities of an agent. These
responsibilities include:
1.
The legal duty to act solely in the interest of the principal and to avoid conflicts of
interest.
2.
The legal duty to keep the principal's property separate and distinct from any other
property owned or controlled by you.
You may not transfer the principal's property to yourself without full and adequate
consideration or accept a gift of the principal's property unless this power of attorney
specifically authorizes you to transfer property to yourself or accept a gift of the principal's
property. If you transfer the principal's property to yourself without specific authorization in
the power of attorney, you may be prosecuted for fraud and/or embezzlement. If the
principal is 65 years of age or older at the time that the property is transferred to you
without authority, you may also be prosecuted for elder abuse under Penal Code Section
368. In addition to criminal prosecution, you may also be sued in civil court.
I have read the foregoing notice and I understand the legal and fiduciary duties
that I assume by acting or agreeing to act as the agent (attorney-in-fact) under the terms
of this power of attorney.
Date:
[Signature of Agent]
[Print Name of Agent]
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CALIFORNIA UNIFORM STATUTORY POWER OF ATTORNEY

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Completed 17 March 2022

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