Fill - Free fillable State of Georgia } STATUTORY FORM POWER OF PDF form

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State of Georgia }

County of ________________ }

STATUTORY FORM POWER OF ATTORNEY

IMPORTANT INFORMATION

This power of attorney authorizes another person (your agent) to make decisions concerning

your property for you (the principal). Your agent will be able to make decisions and act with

respect to your property (including your money) whether or not you are able to act for yourself.

The meaning of authority over subjects listed on this form is explained in O.C.G.A. Chapter 6B

of Title 10.

This power of attorney does not authorize the agent to make health care decisions for you.

You should select someone you trust to serve as your agent. Unless you specify otherwise,

generally the agent's authority will continue until you die or revoke the power of attorney or the

agent resigns or is unable to act for you. If you revoke the power of attorney, you must

communicate your revocation by notice to the agent in writing by certified mail and file such

notice with the clerk of superior court in your county of domicile.

Your agent is not entitled to any compensation unless you state otherwise in the Special

Instructions. Your agent shall be entitled to reimbursement of reasonable expenses incurred in

performing the acts required by you in your power of attorney.

This form provides for designation of one agent. If you wish to name more than one agent, you

may name a successor agent or name a co-agent in the Special Instructions. Co-agents will not be

required to act together unless you include that requirement in the Special Instructions.

If your agent is unable or unwilling to act for you, your power of attorney will end unless you

have named a successor agent. You may also name a second successor agent.

This power of attorney shall be durable unless you state otherwise in the Special Instructions.

This power of attorney becomes effective immediately unless you state otherwise in the Special

Instructions.

If you have questions about the power of attorney or the authority you are granting to your agent,

you should seek legal advice before signing this form.

DESIGNATION OF AGENT

I __________________________ (Name of principal) name the following person as my agent:

Name of agent: __________________________

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Agent's address: __________________________

Agent's telephone number: __________________________

Agent's e-mail address: __________________________

DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)

If my agent is unable or unwilling to act for me, I name as my successor agent:

Name of successor agent: __________________________

Successor agent's address: __________________________

Successor agent's telephone number: __________________________

Successor agent's e-mail address: __________________________

If my successor agent is unable or unwilling to act for me, I name as my second successor agent:

Name of second successor agent: __________________________

Second successor agent's address: __________________________

Second successor agent's telephone number: __________________________

Second successor agent's e-mail address: __________________________

GRANT OF GENERAL AUTHORITY

I grant my agent and any successor agent general authority to act for me with respect to the

following subjects as defined in O.C.G.A. Chapter 6B of Title 10:

(INITIAL each subject you want to include in the agent's general authority. If you wish to grant

general authority over all of the subjects you may initial "all preceding subjects" instead of

initialing each subject.)

_____ Real property

_____ Tangible personal property

_____ Stocks and bonds

_____ Commodities and options

_____ Banks and other financial institutions

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_____ Operation of entity or business

_____ Insurance and annuities

_____ Estates, trusts, and other beneficial interests

_____ Claims and litigation

_____ Personal and family maintenance

_____ Benefits from governmental programs or civil or military service

_____ Retirement plans

_____ Taxes

_____ All preceding subjects

GRANT OF SPECIFIC AUTHORITY (OPTIONAL)

My agent SHALL NOT do any of the following specific acts for me UNLESS I have

INITIALED the specific authority listed below:

(CAUTION: Granting any of the following will give your agent the authority to take actions that

could significantly reduce your property or change how your property is distributed at your

death. INITIAL ONLY the specific authority you WANT to give your agent. You should give

your agent specific instructions in the Special Instructions when you authorize your agent to

make gifts.)

_____ Create, amend, revoke, or terminate an inter vivos trust

_____ Make a gift, subject to the limitations of O.C.G.A. § 10-6B-56 and any Special

Instructions in this power of attorney

_____ Create or change rights of survivorship

_____ Create or change a beneficiary designation

_____ Authorize another person to exercise the authority granted under this power of attorney

_____ Waive the principal's right to be a beneficiary of a joint and survivor annuity, including a

survivor benefit under a retirement plan

_____ Access the content of electronic communications

_____ Exercise fiduciary powers that the principal has authority to delegate

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_____ Disclaim or refuse an interest in property, including a power of appointment

LIMITATION ON AGENT'S AUTHORITY

An agent that is not my ancestor, spouse, or descendant SHALL NOT use my property to benefit

the agent or a person to whom the agent owes an obligation of support unless I have included

that authority in the Special Instructions.

SPECIAL INSTRUCTIONS (OPTIONAL)

You may give special instructions on the following lines (you may add lines or place your

special instructions in a separate document and attach it to the power of attorney):

______________________________________________________________________________

EFFECTIVE DATE

This power of attorney is effective immediately unless I have stated otherwise in the Special

Instructions.

NOMINATION OF CONSERVATOR (OPTIONAL)

If it becomes necessary for a court to appoint a conservator of my estate, I nominate the

following person(s) for appointment:

Name of nominee for conservator of my estate: __________________________

Nominee's address: __________________________

Nominee's telephone number: __________________________

Nominee's e-mail address: __________________________

RELIANCE ON THIS POWER OF ATTORNEY

Any person, including my agent, may rely upon the validity of this power of attorney or a copy

of it unless that person has actual knowledge it has terminated or is invalid.

SIGNATURE AND ACKNOWLEDGMENT

Your signature __________________________ Date _________________________

Your name printed __________________________

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Your address __________________________

Your telephone number __________________________

Your e-mail address __________________________

This document was signed in my presence on __________________________, (Date) by

__________________________ (Name of principal)

Witness Signature __________________________

Witness's name printed __________________________

Witness's address __________________________

Witness's telephone number __________________________

Witness's e-mail address __________________________

State of Georgia }

County of ________________ }

This document was signed in my presence on __________________________ (Date) by

__________________________ (Name of principal).

(Seal)

Signature of notary __________________________

My commission expires __________________________

This document prepared by __________________________

IMPORTANT INFORMATION FOR AGENT

Agent's Duties

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 upon you legal duties that

continue until you resign or the power of attorney is terminated or revoked. You must:

(1) Do what you know the principal reasonably expects you to do with the

principal's property or, if you do not know the principal's expectations, act

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in the principal's best interest;

(2) Act in good faith;

(3) Do nothing beyond the authority granted in this power of attorney; and

(4) Disclose your identity as an agent whenever you act for the

principal by writing or printing the name of the principal and signing your

own name as "agent" in the following manner:

__________________________ by __________________________ as Agent.

(Principal's name) (Your signature)

Unless the Special Instructions in this power of attorney state otherwise, you must also:

(1) Act loyally for the principal's benefit;

(2) Avoid conflicts that would impair your ability to act in the principal's best interest;

(3) Act with care, competence, and diligence;

(4) Keep a record of all receipts, disbursements, and transactions made on behalf of the principal;

(5) Cooperate with any person that has authority to make health care decisions for the principal

to do what you know the principal reasonably expects or, if you do not know the principal's

expectations, to act in the principal's best interest; and

(6) Attempt to preserve the principal's estate plan if you know the plan and preserving the plan is

consistent with the principal's best interest.

Termination of Agent's Authority

You must stop acting on behalf of the principal if you learn of any event that terminates this

power of attorney or your authority under this power of attorney. Events that terminate a power

of attorney or your authority to act under a power of attorney include:

(1) Death of the principal;

(2) The principal's revocation of your authority or the power of attorney so as long as the

revocation of the power of attorney is communicated to you in writing by certified mail and

provided that such notice is filed with the clerk of superior court in the county of domicile of the

principal;

(3) The occurrence of a termination event stated in the power of attorney;

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(4) The purpose of the power of attorney is fully accomplished; or

(5) If you are married to the principal, a legal action is filed with a court to end your marriage, or

for your legal separation, unless the Special Instructions in this power of attorney state that such

an action will not terminate your authority.

Liability of Agent

The meaning of the authority granted to you is defined in O.C.G.A. Chapter 6B of Title 10. If

you violate O.C.G.A. Chapter 6B of Title 10 or act outside the authority granted, you may be

liable for any damages caused by your violation.

If there is anything about this document or your duties that you do not understand, you should

seek legal advice.

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