Power of Attorney Colorado

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

 

Name of agent: _____________________________

 

Agent's address: _____________________________

 

Agent's telephone number: _____________________________

 

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: _____________________________

 

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: _____________________________

 

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 the "Uniform Power of Attorney Act", part 7 of article 14 of title 15, Colorado Revised Statutes:

 

(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

 

GRANT OF SPECIFIC AUTHORITY (OPTIONAL)

 

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" set forth in section 15-14-740, Colorado Revised Statutes, 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, including powers to participate in the designation or changing of a fiduciary and powers to participate in the direction of a fiduciary in the exercise of the fiduciary's powers

 

(____) Disclaim, refuse, or release an interest in property or a power of appointment

 

(____) Exercise a power of appointment other than:

 

(1) The exercise of a general power of appointment for the benefit of the principal which may, if the subject of estates, trusts, and other beneficial interests is authorized above, be exercised as provided under the subject of estates, trusts, and other beneficial interests; or

 

(2) the exercise of a general power of appointment for the benefit of persons other than the principal which may, if the making of a gift is specifically authorized above, be exercised under the specific authorization to make gifts (____) Exercise powers, rights, or authority as a partner, member, or manager of a partnership, limited liability company, or other entity that the principal may exercise on behalf of the entity and has authority to delegate excluding the exercise of such powers, rights, and authority with respect to an entity owned solely by the principal which may, if operation of entity or business is authorized above, be exercised as provided under the subject of operation of the entity or business

 

LIMITATION ON AGENT'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 INSTRUCTIONS (OPTIONAL)

 

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.

 

NOMINATION OF CONSERVATOR

 

OR GUARDIAN (OPTIONAL)

 

If it becomes necessary for a court to appoint a conservator of my estate or guardian of my person, I nominate the following person(s) for appointment:

 

Name of nominee for conservator 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: _____________________________

 

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 knows it has terminated or is invalid.

 

SIGNATURE AND ACKNOWLEDGMENT

 

____________________________________           _______________________

Your signature                                                            Date

 

____________________________________

Your name printed

 

____________________________________

 

____________________________________

Your address

 

____________________________________

Your telephone number

 

State of ________________________

 

[County] of ________________________

 

This document was acknowledged before me on ________________________ (Date)

 

by ________________________ (Name of principal).

 

____________________________________                                     (Seal, if any)

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 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:

(Principal's name) by (Your signature) as agent

 

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 the power of attorney or your authority;

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

(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 the "Uniform Power of Attorney Act", part 7 of article 14 of title 15, Colorado Revised Statutes. If you violate the "Uniform Power of Attorney Act", part 7 of article 14 of title 15, Colorado Revised Statutes, 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.

AGENT'S CERTIFICATION AS TO THE

VALIDITY OF

POWER OF ATTORNEY AND AGENT'S AUTHORITY

 

State of __________________________________

County of __________________________________

 

I, __________________________________ (Name of agent), certify under penalty of perjury that __________________________________ (Name of principal) granted me authority as an agent or successor agent in a power of attorney dated __________________________________.

 

I further certify that to my knowledge:

(1)  The principal is alive and has not revoked the power of attorney or my authority to act under the power of attorney and the power of attorney and my authority to act under the power of attorney have not terminated;

(2)  If the power of attorney was drafted to become effective upon the happening of an event or contingency, the event or contingency has occurred;

(3)  If I was named as a successor agent, the prior agent is no longer able or willing to serve; and

(4)  ________________________________________________________________

_____________________________________ (Insert other relevant statements)

 

SIGNATURE AND ACKNOWLEDGMENT

 

____________________________________           _______________________

Agent’s signature                                                            Date

 

____________________________________

Agent’s name printed

 

____________________________________

 

____________________________________

Agent’s address

 

____________________________________

Agent’s telephone number

 

This document was acknowledged before me on ________________________ (Date)

 

by ________________________ (Name of agent).

 

____________________________________                                     (Seal, if any)

Signature of notary

 

My commission expires: ________________________

 

This document prepared by: ____________________________________