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IOWA GEERAL DURABLE POWER OF ATTOREY

This power of attorney shall not be affected by disability of the principal.

IMPORTAT IFORMATIO

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 the Uniform Power of Attorney Act.

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 revoke the power of

attorney or the agent resigns or is unable to act for you.

Your agent is entitled to reasonable compensation unless you state otherwise in the

Special Instructions.

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

agent you may name a coagent in the Special Instructions. Coagents are not 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 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.

DESIGATIO OF AGET

I _____________________________________________________ name the following

(Name of Principal)

person as my agent:

Name of Agent:

Agent’s Address:

Agent’s Telephone Number:

DESIGATIO OF SUCCESSOR AGET(S) (OPTIOAL)

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

Name of Successor:

Successor Agent’s Address:

Successor Agent’s Telephone Number:

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:

GRAT OF GEERAL AUTHORITY

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

the following subjects as defined in the Uniform Power of Attorney Act:

(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

(___) 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

GRAT OF SPECIFIC AUTHORITY (OPTIOAL)

My agent MAY 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.)

(___) Create, amend, revoke, or terminate an inter vivos trust

(___) Make a gift, subject to the limitations of the Uniform Power of Attorney Act 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

(___) Exercise fiduciary powers that the principal has authority to delegate

(___) Disclaim or refuse an interest in property, including a power of appointment

LIMITATIO O AGET’S AUTHORITY

An agent that is not my ancestor, spouse, or descendant MAY 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 ISTRUCTIOS (OPTIOAL)

You may give special instructions on the following lines:

_____________________________________________________________

________________________________________

EFFECTIVE DATE

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

Special Instructions.

OMIATIO OF COSERVATOR OR GUARDIA (OPTIOAL)

If it becomes necessary for a court to appoint a conservator or guardian of my estate or

guardian of my person, I nominate the following person(s) for appointment:

Name of Nominee for conservator or guardian of my estate:

Nominee’s Address:

Nominee’s Telephone Number:

Name of Nominee for guardian of my person:

Nominee’s Address:

Nominee’s Telephone Number:

RELIACE O THIS POWER OF ATTOREY

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

copy of it unless that person knows it has terminated or is invalid.

SIGATURE AD ACKOWLEDGMET

____________________________________________ _________________

Your Signature Date

____________________________________________

Your Name Printed

____________________________________________

Your Address

____________________________________________

Your Telephone Number

STATEMET OF WITESS

On the date written above, the principal declared to me in my presence that this

instrument is his general durable power of attorney and that he or she had willingly

signed or directed another to sign for him or her, and that he or she executed it as his or

her free and voluntary act for the purposes therein expressed.

WITNESS No. 1

Signature:

Printed Name:

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Address:

WITNESS No. 2:

Signature:

Printed Name:

Address:

CERTIFICATE OF ACKOWLEDGMET OF OTARY PUBLIC

State of Iowa

County of___________________________

Acknowledged before me this ______day of

(month), _________ (year)

by ______________________________ (name of principal). The affiant is (choose one):

____ personally known to me, or ____ produced the following identification:

.

____________________________________________

Signature of Notary

My commission expires: ________________________

(Seal, if any)

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Fillable form is explained in the Uniform Power of

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