DURABLE GENERAL POWER OF ATTORNEY
(NEW YORK STATUTORY SHORT FORM)
THE POWERS YOU GRANT BELOW CONTINUE TO BE EFFECTIVE SHOULD YOU BECOME
DISABLED OR INCOMPETENT
Caution: This Is an Important document. It gives the person whom you designate (your "Agent") broad
powers to handle your property during your lifetime, which may include powers to mortgage, sell, or
otherwise dispose of any real or personal property without advance notice to you or approval by you. These
powers will continue to exist even after you become disabled or incompetent. These powers are explained
more fully In New York General Obligations Law, Article 5, Title 15, Sections 5-1502A through 5-1503, which
expressly permit the use of any other or different form of power of attorney.
This document does not authorize anyone to make medical or other health care decisions. You may execute a
health care proxy to do this.
If there is anything about this form that you do not understand, you should ask a lawyer to explain it to you.
THIS is intended to constitute a DURABLE GENERAL POWER OF ATTORNEY pursuant to Article 5, Title 15 of the
New York General Obligations Law:
I, do hereby
appoint:
(insert your name and address)
(If 1 person is to be appointed agent, insert the name and address of your agent above)
(If 2 or more persons are to be appointed agents by you insert their names and addresses above)
my attorney(s)-in-fact TO ACT
(If more than one agent is designated, CHOOSE ONE of the following two choices by putting your initials in ONE of the blank spaces to the left of your choice)
[ ] Each agent may SEPARATELY act. [ ] All agents must act TOGETHER.
(If neither blank space is initialed, the agents will be required to act TOGETHER)
IN MY NAME, PLACE AND STEAD in any way which I myself could do, if I were personally present, with respect to
the following matters as each of them is defined in Title 15 of Article 5 of the New York General Obligations Law to the
extent that I am permitted by law to act through an agent:
(DIRECTIONS: Initial In the blank space to the left of your choice any one or more of the following lettered
subdivisions as to which you WANT to give your agent authority. If the blank space to the left of any
particular lettered subdivision Is NOT Initialed, NO AUTHORITY WILL BE GRANTED for matters that are
Included In that subdivision. Alternatively, the letter corresponding to each power you wish to grant may be
written or type on the blank line In subdivision "(Q)", and you may then put your Initials In the blank space to
the left of subdivision "(Q)" in order to grant each of the powers so indicated.)
[ ] (A) real estate transactions; [ ]
(M)
[ ] (B) chattel and goods transactions;
[ ] (C) bond, share and commodity
transactions:
[ ] (D) banking transactions;
[ ] (E) business operating transactions; [ ] (N)
making gifts to my spouse, children and
more remote descendants, and,
parents not to exceed in the aggregate
$10,000 to each of such persons in any
year;
tax matters;
[ ] (F) insurance transactions; [ ] (0) all other matters;
[ ] (G) estate transactions; [ ] (P)
[ ] (H) claims and litigation;
[ ] (I) personal relationships and affairs;
[ ] (J) benefits from military service;
[ ] (K) records, reports and statements;
full and unqualified authority to
my attorney(s)-in-fact to delegate any
or all of the foregoing powers to any
person or persons whom my
attorney(s)-in-fact shall select;
[ ] (L) retirement benefit transactions; [ ] (Q) each of the above matters identified by
the following letters: _______________
_______________________________
_
(Special provisions and limitations may be included in the statutory short form durable power of attorney only if they conform to the requirements of Section 5-1503
of the New York General Obligations Law.)
This Durable Power of Attorney shall not be affected by my subsequent disability or incompetence.
If every agent named above is unable or unwilling to serve, I appoint
(insert name and address of successor)
to be my agent for all purposes hereunder.
To induce any third party to act hereunder, I hereby agree that any third party receiving a duly executed copy or
facsimile of this instrument may act hereunder, and that revocation or termination hereof shall be ineffective as to
such third party unless and until actual notice or knowledge of such revocation or termination shall have been
received by such third party, and I for myself and for my heirs, executors, legal representatives and assigns, hereby
agree to indemnify and hold harmless any such third party from and against any and all claims that may arise
against such third party by reason of such third party having relied on the provisions of this instrument.
This Durable General Power of Attorney may be revoked by me at any time.
IN WITNESS WHEREOF, I have hereunto signed my name this day of
(You sign here:) ________________________________________
(Signature of Principal)
ISSUED BY
C
OMMONWEALTH LAND TITLE INSURANCE COMPANY
Commonwealth
A LANDAMERICA COMPANY
Form 2229-2 – with Uniform Acknowledgment
(See over for acknowledgment)
TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE IN NEW YORK STATE
State of New York, County of ss:
On the day of in the year
before me, the undersigned, personally appeared
personally known to me or proved to me on the basis of
satisfactory evidence to be the individual(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
capacity(ies), and that by his/her/their signature(s) on the
instrument, the individual(s), or the person upon behalf of which
the individual(s) acted, executed the instrument.
__________________________________________________
(signature and office of individual taking acknowledgment)
State of New York, County of ss:
On the day of in the year
before me, the undersigned, personally appeared
personally known to me or proved to me on the basis of
satisfactory evidence to be the individual(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
capacity(ies), and that by his/her/their signature(s) on the
instrument, the individual(s), or the person upon behalf of which
the individual(s) acted, executed the instrument.
_________________________________________________
(signature and office of individual taking acknowledgment)
TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE OUTSIDE NEW YORK STATE
State (or District of Columbia, Territory, or Foreign Country) of ss:
On the day of in the year before me, the undersigned, personally appeared
personally known to me or proved to me on the basis of satisfactory evidence to be the individual(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 capacity(ies), and
that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted,
executed the instrument, and that such individual made such appearance before the undersigned in the
_________________________________________ in ___________________________________________________________.
(insert the City or other political subdivision) (and insert the State or Country or other place the acknowledgment was taken)
_______________________________________________________
(signature and office of individual taking acknowledgment)
SECTION
BLOCK
LOT
COUNTY OR TOWN
STREET ADDRESS
DURABLE POWER OF ATTORNEY
NEW YORK STATUTORY SHORT FORM
Title No. ________________________________
TO
Recorded at Request of
COMMONWEALTH LAND TITLE INSURANCE COMPANY
RETURN BY MAIL TO:
Distributed by
Commonwealth
A LANDAMERICA COMPANY
COMMONWEALTH LAND TITLE INSURANCE COMPANY
RESERVE THIS SPACE FOR USE OF RECORDING OFFICE