Sample Form: Durable Power of
Attorney
Go over
this form with your attorney.
POWER OF ATTORNEY- SAMPLE
TO CONSIDER FOR DISCUSSION WITH YOUR ATTORNEY
DURABLE POWER OF ATTORNEY
KNOW ALL MEN BY THESE
PRESENTS, that I, _____________ (the "Grantor") (Social
Security Number: _____________), residing at _____________, being of the
age of majority under the laws of _____________, and of sufficient
capacity to conduct my business and financial affairs, in order to provide
for management of Grantor's financial affairs in a more orderly fashion,
hereby declare as follows:
APPOINTMENT OF AGENT
Grantor hereby makes, constitutes, and appoints ("Grant")
_____________ residing at _____________, as Grantor's true and lawful
attorney-in-fact and agent (the "Agent") for Grantor and in
Grantor's name, place, and stead and for Grantor's benefit, or any
alternate appointed in accordance with the provisions of this Power of
Attorney (the "Agent").
ALTERNATE AGENT If
_____________ is unwilling or unable to act as Agent, Grantor appoints
_____________, who resides at _________________, as Grantor's Agent (the
"Alternate Agent"). If _____________ is unable or unwilling to
serve as Grantor's Agent, then Grantor appoints _____________, who resides
at __________________, as Grantor's Agent. If _____________ is unable or
unwilling to serve as Grantor's Agent, then Grantor appoints
_____________, who resides at __________________, as Grantor's Agent. The
timing of the appointment of the Alternate Agent shall be when the prior
named Agent or Alternate Agent is unwilling or unable to act. Any rights
or powers granted to the Agent are granted to the Alternate Agent.
DIRECTION TO SUPPORT
GRANTOR AND DESIGNATED PERSONS The Agent is hereby authorized and
directed to do all acts reasonable and necessary to maintain Grantor's
customary standard of living: to provide living quarters by purchase,
lease, or other arrangement, or by payment of the operating costs of
Grantor's existing living quarters, including interest, amortization
payments, repairs, taxes, and so forth; to provide for the retention and
payment of reasonably necessary domestic help for the maintenance and
operation of Grantor's household; to finance or arrange for the purchase
of other necessaries, including but not limited to clothing,
transportation, entertainment, and incidentals; and to provide medical
care. The Agent is further authorized and directed to provide for the
health, education, support, and maintenance of Grantor's spouse, and
Grantor's _____________, _____________, _____________ in accordance with
an ascertainable standard as defined in Code Section 2041 and the
Regulations thereunder.
POWERS OF AGENT
The Agent is hereby granted
all the powers and rights necessary to effect Grantor's wishes, including,
in addition to any power authorized by the laws of _____________ for an
agent, the following:
General Financial
Matters: Request, ask, demand, sue for, recover, sell, collect,
forgive, receive, and hold money, debts, dues, commercial paper, checks,
drafts, accounts, deposits, legacies, bequests, devises, notes, interests,
stocks, bonds, certificates of deposit, annuities, pension and retirement
benefits, insurance proceeds, any and all documents of title, choses in
action, personal and real property, intangible and tangible property and
property rights, and demands whatsoever, liquidated or unliquidated, as
now are or may become owned by, or due, owing, payable, or belonging to
Grantor, or in which Grantor has or may hereafter acquire interest. Agent
may use and take all lawful means and equitable and legal remedies,
procedures, and writs in Grantor's name for the collection and recovery of
the above; and may adjust, sell, compromise, and agree for the same; and
to make, execute, and deliver for Grantor, on Grantor's behalf and in
Grantor's name, all endorsements, acceptances, releases, receipts, or
other sufficient discharges for the same.
Tax Returns and Related
Tax Matters: Prepare, sign, and file joint or separate income tax
returns or declarations or estimated tax for any year or years; prepare,
sign, and file gift tax returns with respect to gifts made by Grantor, or
by Grantor's Agent on Grantor's behalf, for any year or years; to utilize
any gift-splitting provision or other tax election; and prepare, sign and
file any claim for refund of any tax. This power is in addition to and not
in limitation of the specific tax powers granted below.
Business: Conduct,
engage in, and transact any lawful business of any nature on Grantor's
behalf and in Grantor's name. Maintain, improve, invest, manage, insure,
lease, or encumber, and in any manner deal with any real, personal,
tangible, or intangible, property, or any interest in them, that Grantor
now owns or may acquire, in Grantor's name and for Grantor's benefit, upon
such terms and conditions as Agent shall deem proper. Conduct or
participate in any business of any nature for Grantor and in Grantor's
name; execute partnership agreements and amendments thereto; incorporate,
reorganize, merge, consolidate, recapitalize, sell, liquidate, or dissolve
any business; elect or employ officers, directors, and agents. Carry out
the provisions of any agreement for the sale of any business interest or
the stock therein; and exercise voting rights with respect to stock,
either in person or by proxy; and exercise stock options.
Social Security and
Government Benefits: Apply to any governmental agency for any benefit
or government obligation to which Grantor may be entitled; endorse any
drafts or checks made payable to Grantor from any such agency.
Contract, Real Estate,
and Other Matters: Exercise or perform any act, power, duty, right, or
obligation that Grantor now has, or may acquire, including the legal
right, power, or capacity to exercise or perform in connection with,
arising from, or relating to any person or property, real or personal,
tangible or intangible, or matter whatsoever, including, without limiting
the foregoing, the right to execute a deed or security agreement, or to
release a security agreement; to enter into a contract of sale and to sell
any real, personal, tangible, or intangible property on Grantor's behalf.
Securities and
Investments: Make, receive, sign, endorse, acknowledge, deliver, and
possess documents of title, bonds, debentures, checks, drafts, stocks,
proxies, or warrants, relating to accounts or deposits, or certificates of
deposit, other debts and obligations, and such other instruments in
writing of whatever kind and nature as may be necessary or proper in the
exercise of the rights and powers herein granted. Sell any and all shares
of stocks, bonds, or other securities now or later belonging to Grantor
that may be issued by any association, trust, or corporation, whether
private or public; and make, execute, and deliver any assignment, or
assignments, of any such shares of stocks, bonds, or other securities.
Legal Actions:
Settle, adjust, compromise, or submit to arbitration any accounts, claims,
debts, demands, disputes, or other matters between Grantor and any other
person or entity, or which concern any property, right, title, interest,
or estate. Begin, prosecute, enforce, abandon, defend, or settle all
claims or judicial or administrative proceedings.
Benefit Plans:
Redeem, borrow, amend, cancel, pledge, surrender, alter, or change the
beneficiary of any retirement, benefit, or pension plan.
Employment of
Accountants, Advisers, and Others: Employ and compensate investment
advisers, banks, accountants, attorneys, real estate and other brokers,
and other professionals which the Agent reasonably deems necessary.
Safe-Deposit Box:
Have access at any time or times to any safe-deposit box rented by
Grantor, or for which Grantor is a co-tenant, remove all or any part of
the contents thereof, and surrender or relinquish any safe-deposit box. No
institution in which any safe-deposit box may be located shall incur any
liability to Grantor or Grantor's estate as a result of permitting the
Agent to exercise the powers herein granted.
Gifts: Make outright
gifts of cash or property to an adult, or to a person under the age of
majority under applicable State law under the State Gifts to Minors' Act
or Transfers to Minors' Act in custodial form, or to a trust for the
benefit of any such minor.
Gifts made under this
authority, to each donee in any calendar year shall not exceed the maximum
amount which is excluded as a taxable gift under Code Section 2503(b) and
2503(e), or any successor statute, effective as of the date of any gift.
Although this amount is presently limited to $10,000 ($20,000 for gifts
split with Grantor's spouse), and amounts paid for educational or medical
expenses (as defined under Code Section 2503(e)), Grantor understands that
this amount may be changed by legislation following the execution of this
Power of Attorney.
Permissible donees
("Authorized Donees") hereunder shall include Grantor's spouse,
any child of Grantor and their descendants, but not any person who shall
be married to any of the foregoing.
The power granted in this
paragraph may be exercised by the Agent without regard to any laws
concerning self-dealing. Grantor specifically grants to the Agent the
right to make gifts to himself or herself, and their issue if such persons
are within the class of permissible donees as defined in this paragraph.
Grantor grants to the Agent the power to prepare, sign, and file gift tax
returns with respect to gifts made by Grantor, or by the Agent on
Grantor's behalf, for any year or years; to consent to any gift and to
utilize any gift-splitting provision or other tax election relating
thereto. This power is in addition to and not in limitation of the
specific tax powers granted below.
Disclaimers: Execute
a qualified disclaimer without court approval under State law, and/or
under Code Section 2518. A disclaimer may be exercised as to part or all
of any asset, interest, gift, or transfer of any kind or nature that may
pass to Grantor under any instrument or transaction.
Insurance: Make,
receive, sign, endorse, acknowledge, deliver, and possess insurance
policies. Execute any forms to change ownership or beneficiaries of any
life insurance policy on Grantor's life. However, new beneficiaries may
only include: Authorized Donees, a trust for Authorized Donees are
beneficiaries, a corporation or partnership in which Grantor is a
shareholder or partner, another shareholder or partner in a corporation or
partnership in which Grantor is a shareholder or partner, Grantor's
estate, or any trust of which Grantor is a grantor, trustee, or
beneficiary.
ADDITIONAL POWERS
In addition to, and not by
way of limitation upon, any other powers conferred upon Grantor's Agent
herein, Grantor grants to the Agent full power and authority to do, take,
and perform each and every act and thing whatsoever requisite, proper, or
necessary to be done in the exercise of any of the rights and powers
herein granted, or available under law to an attorney-in-fact, as fully to
all intents and purposes as Grantor might or could do if personally
present, with full power of substitution or revocation, hereby ratifying
and confirming all that said Agent shall lawfully do or cause to be done
by virtue of this Power of Attorney and the rights and powers herein
granted.
POWERS RELATING TO TAX
MATTERS
In addition to, and not by
way of limitation upon, any other powers conferred upon Grantor's Agent
herein, Grantor grants to the Agent full power and authority to do, take,
and perform each and every act and thing whatsoever requisite, proper, or
necessary to be done in connection with the following: executing and
filing any and all tax returns; receiving and cashing any refund checks
with respect to any tax filing; preparing, signing, and filing joint or
separate income tax returns or declarations or estimated tax for any year
or years [as provided in Treasury Regulation Section 1.6012-1(a)(5) and
Treasury Regulation Section 25.6019-1(d)]; and dealing with the Internal
Revenue Service and any federal, state, local, and foreign tax authority
concerning any gift, estate, inheritance, income, or other tax, and any
audit or investigation of same. This power shall include, by way of
example and not limitation, the power to do all acts that could be
authorized by Grantor having properly executed a Form 2848, "Power of
Attorney and Declaration of Representative," granting the broadest
powers provided therein to the Agent, the power to represent Grantor in
any federal, state, local, or foreign tax matter, to perform all acts that
Grantor could perform relating thereto, to receive checks in payment of
any tax refund, to execute and file petitions with the United States Tax
Court, to execute waivers of restrictions on assessment or collection of
tax deficiencies, to execute a tax protest, to execute consents to the
extension of the period for assessment or collection of tax, to enter into
a closing agreement, to substitute another person to act as Agent with
respect to tax matters, and to perform all other acts necessary and
related to these acts.
COMPENSATION
No Agent or Alternate Agent
hereunder shall be entitled to any compensation for the services rendered.
APPROVAL
Grantor hereby approves and
confirms all acts done by Grantor's Agent on Grantor's behalf. Grantor
hereby ratifies and confirms all that the Agent shall do or cause to be
done, by virtue of this Power of Attorney.
DURABLE POWER –
DISABILITY DOES NOT AFFECT GRANT
This Power of Attorney shall
not be affected by Grantor's subsequent disability as principal. Grantor
does hereby so provide, it being Grantor's intention that all powers
conferred upon the Agent herein shall remain at all times in full force
and effect, notwithstanding Grantor's subsequent incapacity, disability,
or any uncertainty with regard thereto.
THIRD PARTY RELIANCE
Third parties may rely upon
the representations of the Agent for all matters relating to any power
granted to the Agent, and no person who may act in reliance upon the
representations of the Agent or the authority granted to the Agent shall
incur any liability to Grantor or Grantor's estate as a result of
permitting the Agent to exercise any power. Any third party may rely on a
duly executed counterpart of this instrument as fully and completely as if
such third party had received the original of this instrument. Any third
party may rely on the authority of any Alternate Agent when such Alternate
Agent presents an original executed copy of this Power of Attorney. Such
third party need not request proof, other than an affidavit of the
Alternate Agent, under oath, that any prior named Agent is unable or
unwilling to serve in such capacity.
TERMINATION OF GRANT
Revocation of Power by
Grantor: In addition to any other method permitted by law, Grantor may
revoke this Power of Attorney by destroying all executed copies of this
Power of Attorney, or revoke the power granted to any one or more of the
Agent or Alternate Agent(s) by giving written notice to such Agent or
Alternate Agent via certified mail return receipt requested, overnight
courier, or hand delivery, at the address set forth herein for such Agent
or Alternate Agent, unless Grantor has knowledge that such Agent or
Alternate Agent has a different address.
This Power of Attorney is
not coupled with an interest and there is no agreement between Grantor and
the Agent or Alternate Agent(s) limiting or restricting in any manner
Grantor's right to revoke this Power of Attorney.
Termination by Disability
or Death of Agent: The Grant of this Power of Attorney to the Agent
shall terminate at the earlier of the date of his or her substantial
disability, or the delivery of a writing to such Agent executed by
Grantor, prior to Grantor's death or disability, terminating such Grant.
Resignation of Agent:
Any Agent may resign by providing written notice to Grantor (or Grantor's
guardian or committee) with copy to the next named Agent or a court of
competent Jurisdiction.
Validity of Acts
Following Revocation: Any act of the Agent between the revocation of
this Power of Attorney and notice of that revocation to the Agent shall be
valid unless the Agent, or other person claiming the benefit of the act,
had actual knowledge of that revocation.
Affidavit Sufficient
Proof for Third Party: It shall be sufficient proof for any third
party relying on this document, if such third party has no actual
knowledge of the termination of this agreement (without any duty of
inquiry being imposed on such third party), that the Agent shall provide
an affidavit that this Power of Attorney has not terminated under oath.
CONSTRUCTION
This instrument is to be
construed and interpreted as a durable general power of attorney. The
enumeration of specific items, rights, acts, or powers herein is not
intended to nor does it limit or restrict, and is not to be construed or
interpreted as limiting or restricting, the general powers herein granted
to the Agent. This instrument is executed in the state of _____________
("State"), and the laws of State shall govern all questions as
to the validity of this power and the construction of its provisions. It
is Grantor's intention, however, that this power of attorney be
exercisable in any other state or jurisdiction in which Grantor may at any
time have property, business, or other dealings. Should any provision or
power in this document not be enforceable, such enforceability shall not
affect the enforceability of the rest of this document. Any references to
the "Code" or any Sections of the Code are references to the
Internal Revenue Code of 1986 and shall include any successor or amended
Code, statute, or regulation. Captions, titles, and section numbers (and
letter designations) are inserted for convenience only and should not be
read to broaden or limit the scope of any provision. Gender, singular or
plural, shall be interpreted as the context requires.
STATE LAW
This instrument is delivered
in the State, and the laws of the State shall govern all questions as to
the validity of this power and the construction of its provisions. The
Agent is, notwithstanding anything herein to the contrary, granted the
right to exercise of any of the rights and powers available under the laws
of the State. This power of attorney shall not be affected by disability
of the principal. This provision shall be interpreted in the broadest
terms so as to remain in effect throughout Grantor's disability to the
fullest extent provided for under the laws of the state of the State.
IN WITNESS WHEREOF, I
have hereunto set my hand and seal this _______________ day of
________________, 200____, acknowledging that I have read and understood
the powers and rights herein granted and that Grantor voluntarily chooses
to make the Grant.
Grantor/Principal
__________________________
Witness 1: Name:
__________________________
Address:
__________________________
Signature:
__________________________
Witness 2: Name:
__________________________
Address:
__________________________
Signature:
__________________________
State of _______________)
County of _______________)
On this _____________ day of
_______________, 200 ___, I, a Notary Public in the State of
_____________, certify that before me personally appeared _____________,
who resides at _____________, and who I am satisfied is the person named
in and who executed the within Power of Attorney, and who acknowledged
under oath, and to my satisfaction, that the execution of the Power of
Attorney by Grantor was done voluntarily for the uses and purposes therein
expressed, and that Grantor, signed, sealed, and delivered the Power of
Attorney as Grantor's act and deed. The execution of this Power of
Attorney by the Grantor was done in my presence and in the presence of
both witnesses above, each of whom signed their names in my presence and
in Grantor's presence.
_______________________________________
Notary Public, State of
_____________
My commission expires on:
_____________, 200____