Free Printable Power of Attorney Form Kentucky

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 the following person as my agent:

                (Name of Principal)

 

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 unwilling or unable 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 in KRS Chapter

457:

 

(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 in

KRS 457.400 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

(___) Access the content of electronic communications

 

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 ________________________, 20____

 

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 in KRS Chapter 457. If you violate the Uniform Power of Attorney Act under KRS

Chapter 457 or act outside the authority granted, you may be liable for any damages

caused by your violation.