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DURABLE FINANCIAL POWER OF ATTORNEY
On the ___ day of __________________, 20____ I, __________________, the
principal, of __________________, State of __________________, hereby designate
__________________, of __________________, State of __________________, my
attorney-in-fact (hereinafter my “attorney-in-fact”), to act as initialed below, in my name,
in my stead and for my benefit, hereby revoking any and all financial powers of attorney
I may have executed in the past.
EFFECTIVE DATE
(Choose the applicable paragraph by placing your initials in the preceding space)
________ - A. I grant my attorney-in-fact the powers set forth herein immediately upon
the execution of this document. These powers shall not be affected by any subsequent
disability or incapacity I may experience in the future.
or
________ - B. I grant my attorney-in-fact the powers set forth herein only when it has
been determined in writing, by my attending physician, that I am unable to properly
handle my financial affairs.
POWERS OF ATTORNEY-IN-FACT
My attorney-in-fact shall exercise powers in my best interests and for my welfare, as a
fiduciary. My attorney-in-fact shall have the following powers:
(Choose the applicable power(s) by placing your initials in the preceding space)
________ BANKING - To receive and deposit funds in any financial institution, and to
withdraw funds by check or otherwise to pay for goods, services, and any other
personal and business expenses for my benefit. If necessary to effect my attorney-in-
fact’s powers, my attorney-in-fact is authorized to execute any document required to be
signed by such banking institution.
________ SAFE DEPOSIT BOX - To have access at any time or times to any safe-
deposit box rented by me or to which I may have access, wheresoever located,
including drilling, if necessary, and to remove all or any part of the contents thereof, and
to surrender or relinquish said safe-deposit box; and any institution in which any such
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safe-deposit box may be located shall not incur any liability to me or my estate as a
result of permitting my attorney-in-fact to exercise this power.
_________ LENDING OR BORROWING - To make loans in my name; to borrow
money in my name, individually or jointly with others; to give promissory notes or other
obligations therefor; and to deposit or mortgage as collateral or for security for the
payment thereof any or all of my securities, real estate, personal property, or other
property of whatever nature and wherever situated, held by me personally or in trust for
my benefit.
________ GOVERNMENT BENEFITS - To apply for and receive any government
benefits for which I may be eligible or become eligible, including but not limited to,
Social Security, Medicare and Medicaid.
________ RETIREMENT PLAN - To contribute to, select payment option of, roll-over,
and receive benefits of any retirement plan or IRA I may own, except my attorney-in-fact
shall not have power to change the beneficiary of any of my retirement plans or IRAs.
________ TAXES - To complete and sign any local, state and federal tax returns on my
behalf, pay any taxes and assessments due and receive credits and refunds owed to
me and to sign any tax agency documents necessary to effectuate these powers.
________ INSURANCE - To purchase, pay premiums and make claims on life, health,
automobile and homeowners' insurance on my behalf, except my attorney-in-fact shall
not have the power to cash in or change the beneficiary of any life insurance policy.
________ REAL ESTATE - To acquire, purchase, exchange, lease, grant options to
sell, and sell and convey real property, or any interests therein, on such terms and
conditions, including credit arrangements, as my attorney-in-fact shall deem proper; to
execute, acknowledge and deliver, under seal or otherwise, any and all assignments,
transfers, deeds, papers, documents or instruments which my attorney-in-fact shall
deem necessary in connection therewith.
________ PERSONAL PROPERTY - To acquire, purchase, exchange, lease, grant
options to sell, and sell and convey personal property, or any interests therein, on such
terms and conditions, including credit arrangements, as my 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 which my attorney-in-
fact shall deem necessary in connection therewith; to purchase, sell or otherwise
dispose of, assign, transfer and convey shares of stock, bonds, securities and other
personal property now or hereafter belonging to me, whether standing in my name or
otherwise, and wherever situated.
_________ POWER TO MANAGE PROPERTY- To maintain, repair, improve, invest,
manage, insure, rent, lease, encumber, and in any manner deal with any real or
personal property, tangible or intangible, or any interests therein, that I now own or may
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hereafter acquire, in my name and for my benefit, upon such terms and conditions as
my attorney-in-fact shall deem proper.
_________ GIFTS - To make gifts, grants, or other transfers (including the forgiveness
of indebtedness and the completion of any charitable pledges I may have made) without
consideration, either outright or in trust to such person(s) (including my attorney-in-fact
hereunder) or organizations as my attorney-in-fact shall select, including, without
limitation, the following actions: (a) transfer by gift in advancement of a bequest or
devise to beneficiaries under my will or in the absence of a will to my spouse and
descendants in whatever degree; and (b) release of any life interest, or waiver,
renunciation, disclaimer, or declination of any gift to me by will, deed, or trust
________ LEGAL ADVICE AND PROCEEDINGS - To obtain and pay for legal advice,
to initiate or defend legal and administrative proceedings on my behalf, including actions
against third parties who refuse, without cause, to honor this instrument.
SPECIAL INSTRUCTIONS: On the following lines are any special instructions limiting
or extending the powers I give to my attorney-in-fact (Write “None” if no additional
instructions are given):
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
AUTHORITY OF ATTORNEY-IN-FACT: Any party dealing with my attorney-in-fact
hereunder may rely absolutely on the authority granted herein and need not look to the
application of any proceeds nor the authority of my attorney-in-fact as to any action
taken hereunder. In this regard, no person who may in good faith act in reliance upon
the representations of my attorney-in-fact or the authority granted hereunder shall incur
any liability to me or my estate as a result of such act. I hereby ratify and confirm
whatever my attorney-in-fact shall lawfully do under this instrument. My attorney-in-fact
is authorized as he or she deems necessary to bring an action in court so that this
instrument shall be given the full power and effect that I intend on by executing it.
LIABILITY OF ATTORNEY-IN-FACT: My attorney-in-fact shall not incur any liability to
me under this power except for a breach of fiduciary duty.
REIMBURSEMENT OF ATTORNEY-IN-FACT: My attorney-in-fact is entitled to
reimbursement for reasonable expenses incurred in exercising powers hereunder, and
to reasonable compensation for services provided as attorney-in-fact.
AMENDMENT AND REVOCATION: I can amend or revoke this power of attorney
through a writing delivered to my attorney-in-fact. Any amendment or revocation is
ineffective as to a third party until such third party has notice of such revocation or
amendment.
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STATE LAW: This Power of Attorney is governed by the laws of the State of
______________________.
PHOTOCOPIES: Photocopies of this document can be relied upon as though they were
originals.
IN WITNESS WHEREOF, I have on this ____ day of __________________, 20____,
executed this Financial Power of Attorney.
__________________________________
Principal’s Signature
We, the witnesses, each do hereby declare in the presence of the principal that the
principal signed and executed this instrument in the presence of each of us, that the
principal signed it willingly, that each of us hereby signs this Power of Attorney as
witness at the request of the principal and in the principal’s presence, and that, to the
best of our knowledge, the principal is eighteen years of age or over, of sound mind,
and under no constraint or undue influence.
________________________________________
Witness’s Signature
________________________________________
Address
_________________________________________
Witness’s Signature
________________________________________
Address
STATE OF __________________
__________________ County, ss.
On this ____ day of __________________, 20____, before me appeared
____________________, as Principal of this Power of Attorney who proved to me
through government issued photo identification to be the above-named person, in my
presence executed foregoing instrument and acknowledged that (s)he executed the
same as his/her free act and deed.
____________________
Notary Public
My commission expires: ___________
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SPECIMEN SIGNATURE AND ACCEPTANCE OF APPOINTMENT
I, ____________________, the attorney-in-fact named above, hereby accept
appointment as attorney-in-fact in accordance with the foregoing instrument.
______________________________
Attorney-in-Fact’s Signature
STATE OF __________________
__________________ County, ss.
On this ____ day of __________________, 20____, before me appeared
____________________, as Attorney-in-Fact of this 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: ___________
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signature
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