Power of Attorney Forms New York

 

I, ______________________, with a mailing address of ______________________, City of ______________________, State of New York, hereby appoint: ______________________, with a mailing address of ______________________, City of ______________________, State of New York as my agent.

 

INITIAL ONE (1)

 

_____ - There shall be no other Agents.

 

_____ - There shall be another Agent known as ______________________, with a mailing address of ______________________, City of ______________________, State of New York as my agent.

 

If you designate more than one agent above, and you do not initial the statement below, they must act together.

 

_____ - My agents may act SEPARATELY.

 

(c) DESIGNATION OF SUCCESSOR AGENT(S): (OPTIONAL) (INITIAL)

 

_____ - There shall be no Successor Agents.

 

_____ - There shall be a Successor Agent known as ______________________, with a mailing address of ______________________, City of ______________________, State of New York.

 

_____ - There shall be a Successor Agent known as ______________________, with a mailing address of ______________________, City of ______________________, State of New York.

 

If you do not initial the statement below, successor agents designated above must act together.

 

_____ - My Successor Agents may act SEPARATELY.

 

You may provide for specific succession rules in this section. Insert specific succession provisions here: ________________________________________________________

 

(d) THIS POWER OF ATTORNEY shall not be affected by my subsequent incapacity unless I have stated otherwise below, under "Modifications".

 

(e) THIS POWER OF ATTORNEY DOES NOT REVOKE any Powers of Attorney previously executed by me unless I have stated otherwise below, under "Modifications."

 

(f) GRANT OF AUTHORITY:

 

To grant your agent some or all of the authority below, either

 

(1) Initial the bracket at each authority you grant, or (2) Write or type the letters for each authority you grant on the blank line at (P), and initial the bracket at (P). If you initial (P), you do not need to initial the other lines.

 

I grant authority to my agent(s) with respect to the following subjects as defined in sections 5-1502A through 5-1502N of the New York General Obligations Law:

 

_____ - (A) real estate transactions;

 

_____ - (B) chattel and goods transactions;

 

_____ - (C) bond, share, and commodity transactions;

 

_____ - (D) banking transactions;

 

_____ - (E) business operating transactions;

 

_____ - (F) insurance transactions;

 

_____ - (G) estate transactions;

 

_____ - (H) claims and litigation;

 

_____ - (I) personal and family maintenance. If you grant your agent this authority, it will allow the agent to make gifts that you customarily have made to individuals, including the agent, and charitable organizations. The total amount of all such gifts in any one calendar year cannot exceed five hundred dollars;

 

_____ - (J) benefits from governmental programs or civil or military service;

 

_____ - (K) health care billing and payment matters; records, reports, and statements;

 

_____ - (L) retirement benefit transactions;

 

_____ - (M) tax matters;

 

_____ - (N) all other matters;

 

_____ - (O) full and unqualified authority to my agent(s) to delegate any or all of the foregoing powers to any person or persons whom my agent(s) select;

 

_____ - (P) EACH of the matters identified by the following letters _________________.

 

You need not initial the other lines if you initial line (P).

 

(g) CERTAIN GIFT TRANSACTIONS: STATUTORY GIFTS RIDER (OPTIONAL)

 

In order to authorize your agent to make gifts in excess of an annual total of $5,000 for all gifts described in (I) of the grant of authority section of this document (under personal and family maintenance), and/or to make changes to interest in your property, you must expressly grant that authorization in the Modifications section below. If you wish to authorize your agent to make gifts to himself or herself, you must expressly grant such authorization in the Modifications section below. Granting such authority to your agent gives your agent the authority to take actions which could significantly reduce your property and/or change how your property is distributed at your death. Your choice to grant such authority should be discussed with a lawyer.

 

_____ - I grant my agent authority to make gifts in accordance with the terms and conditions of the Modifications that supplement this Statutory Power of Attorney.

 

(h) MODIFICATIONS: (OPTIONAL)

 

In this section, you may make additional provisions, including, but not limited to, language to limit or supplement authority granted to your agent, language to grant your agent the specific authority to make gifts to himself or herself, and/or language to grant your agent the specific authority to make other gift transactions and/or changes to interests in your property. Your agent is entitled to be reimbursed from your assets for reasonable expenses incurred on your behalf. In this section, you may make additional provisions if you ALSO wish your agent(s) to be compensated from your assets for services rendered on your behalf, and you may define “reasonable compensation.”

 

______________________________________________________________________

 

(i) DESIGNATION OF MONITOR(S): (OPTIONAL)

 

If you wish to appoint monitor(s), initial and fill in the section below:

 

_____ - I wish to designate ______________________, whose address(es) is (are)  ____________________________________________________________, as monitor(s). Upon the request of the monitor(s), my agent(s) must provide the monitor(s) with a copy of the power of attorney and a record of all transactions done or made on my behalf. Third parties holding records of such transactions shall provide the records to the monitor(s) upon request.

 

(j) COMPENSATION OF AGENT(S):

 

Your agent is entitled to be reimbursed from your assets for reasonable expenses incurred on your behalf. If you ALSO wish your agent(s) to be compensated from your assets for services rendered on your behalf, and/or you wish to define “reasonable compensation”, you may do so above, under “Modifications”.

 

(k) ACCEPTANCE BY THIRD PARTIES: I agree to indemnify the third party for any claims that may arise against the third party because of reliance on this Power of Attorney. I understand that any termination of this Power of Attorney, whether the result of my revocation of the Power of Attorney or otherwise, is not effective as to a third party until the third party has actual notice or knowledge of the termination.

 

(l) TERMINATION: This Power of Attorney continues until I revoke it or it is terminated by my death or other event described in section 5-1511 of the General Obligations Law.

Section 5-1511 of the General Obligations Law describes the manner in which you may revoke your Power of Attorney, and the events which terminate the Power of Attorney.

 

(m) SIGNATURE AND ACKNOWLEDGMENT:

 

In Witness Whereof I have hereunto signed my name on __________________, 20___.

 

PRINCIPAL’S SIGNATURE __________________________________________

 

STATE OF NEW YORK

COUNTY OF _______________________

 

On the ____ day of __________________ in the year 20___ before me, the undersigned notary public, personally appeared _______________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument.

 

____________________________________

Notary Public Signature

 

(n) SIGNATURES OF WITNESSES:

 

By signing as a witness, I acknowledge that the principal signed the Power of Attorney in my presence and in the presence of the other witness, or that the principal acknowledged to me that the principal's signature was affixed by him or her or at his or her direction. I also acknowledge that the principal has stated that this Power of Attorney reflects his or her wishes and that he or she has signed it voluntarily. I am not named herein as an agent or as a permissible recipient of gifts.

 

 

____________________________                            ____________________________

Signature of Witness 1                                                Signature of Witness 2

____________________________                            ____________________________

Date                                                                            Date

____________________________                            ____________________________

Print Name                                                                  Print Name

____________________________                            ____________________________

Address                                                                      Address

____________________________                            ____________________________

City, State, Zip Code                                                  City, State, Zip Code

 

 

This document prepared by: _______________________________________________

 

 

(o) IMPORTANT INFORMATION FOR THE AGENT:

 

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 on you legal responsibilities that continue until you resign or the Power of Attorney is terminated or revoked. You must:

 

(1) act according to any instructions from the principal, or, where there are no instructions, in the principal's best interest;

 

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

 

(3) keep the principal's property separate and distinct from any assets you own or control, unless otherwise permitted by law;

 

(4)  keep a record of all transactions conducted for the principal or keep all receipts of payments and transactions conducted for the principal; and

 

(5) disclose your identity as an agent whenever you act for the principal by writing or printing the principal's name and signing your own name as "agent" in either of the following manners: (Principal's Name) by (Your Signature) as Agent, or (your signature) as Agent for (Principal's Name).

 

You may not use the principal's assets to benefit yourself or anyone else or make gifts to yourself or anyone else unless the principal has specifically granted you that authority in the modifications section of this document or a Non-Statutory Power of Attorney. If you have that authority, you must act according to any instructions of the principal or, where there are no such instructions, in the principal's best interest. You may resign by giving written notice to the principal and to any co-agent, successor agent, monitor if one has been named in this document, or the principal's guardian if one has been appointed. If there is anything about this document or your responsibilities that you do not understand, you should seek legal advice.

 

Liability of Agent:

 

 

The meaning of the authority given to you is defined in New York's General Obligations Law, Article 5, Title 15. If it is found that you have violated the law or acted outside the authority granted to you in the Power of Attorney, you may be liable under the law for your violation.

 

(p) AGENT'S SIGNATURE AND ACKNOWLEDGMENT OF APPOINTMENT:

 

It is not required that the principal and the agent(s) sign at the same time, nor that multiple agents sign at the same time.

 

I/we, ___________________________________________, have read the foregoing Power of Attorney. I am/we are the person(s) identified therein as agent(s) for the principal named therein.

 

I/we acknowledge my/our legal responsibilities.

 

In Witness Whereof I have hereunto signed my name on ________________ 20_____.

 

 

Agent(s) Signature __________________________________________

 

Agent(s) Signature __________________________________________

 

STATE OF NEW YORK

COUNTY OF _______________________

 

On the ____ day of __________________ in the year 20___ before me, the undersigned notary public, personally appeared _______________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument.

 

____________________________________

Notary Public

 

(q) SUCCESSOR AGENT'S SIGNATURE AND ACKNOWLEDGMENT OF APPOINTMENT:

 

It is not required that the principal and the SUCCESSOR agent(s), if any, sign at the same time, nor that multiple SUCCESSOR agents sign at the same time. Furthermore, successor agents cannot use this power of attorney unless the agent(s) designated above is/are unable or unwilling to serve.

 

I/we, ___________________________________________, have read the foregoing Power of Attorney. I am/we are the person(s) identified therein as SUCCESSOR agent(s) for the principal named therein.

 

In Witness Whereof I have hereunto signed my name on ________________ 20_____.

 

 

Successor Agent(s) Signature ______________________________________

 

Successor Agent(s) Signature ______________________________________

 

STATE OF NEW YORK

COUNTY OF _______________________

 

On the ____ day of __________________ in the year 20___ before me, the undersigned notary public, personally appeared _______________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument.

 

____________________________________

Notary Public