Power of Attorney New York Statutory Short FormEffective 9109

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1、N.Y. Statutory Short Form Power of Attorney Effective 09-01-09 POWER OF ATTORNEY NEW YORK STATUTORY SHORT FORM (a) CAUTION TO THE PRINCIPAL: Your Power of Attorney is an important document. As the “principal,” you give the person whom you choose (your “agent”) authority to spend your money and sell

2、or dispose of your property during your lifetime without telling you. You do not lose your authority to act even though you have given your agent similar authority. When your agent exercises this authority, he or she must act according to any instructions you have provided or, where there are no spe

3、cific instructions, in your best interest. “Important Information for the Agent” at the end of this document describes your agents responsibilities. Your agent can act on your behalf only after signing the Power of Attorney before a notary public. You can request information from your agent at any t

4、ime. If you are revoking a prior Power of Attorney by executing this Power of Attorney, you should provide written notice of the revocation to your prior agent(s) and to the financial institutions where your accounts are located. You can revoke or terminate your Power of Attorney at any time for any

5、 reason as long as you are of sound mind. If you are no longer of sound mind, a court can remove an agent for acting improperly. Your agent cannot make health care decisions for you. You may execute a “Health Care Proxy” to do this. The law governing Powers of Attorney is contained in the New York G

6、eneral Obligations Law, Article 5, Title 15. This law is available at a law library, or online through the New York State Senate or Assembly websites, www.senate.state.ny.us or www.assembly.state.ny.us. If there is anything about this document that you do not understand, you should ask a lawyer of y

7、our own choosing to explain it to you. (b) DESIGNATION OF AGENT(S): I, , hereby appoint:name and address of principalas my agent(s)name(s) and address(es) of agent(s)If you designate more than one agent above, they must act together unless you initial the statement below. () My agents may act SEPARA

8、TELY. (c) DESIGNATION OF SUCCESSOR AGENT(S): (OPTIONAL) If every agent designated above is unable or unwilling to serve, I appoint as my successor agent(s): name(s) and address(es) of successor agent(s) Successor agents designated above must act together unless you initial the statement below. () My

9、 successor agents may act SEPARATELY. (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 REVOKES any and all prior Powers of Attorney executed by me unless I have stated otherwise below,

10、under “Modifications.” If you are NOT revoking your prior Powers of Attorney, and if you are granting the same authority in two or more Powers of Attorney, you must also indicate under “Modifications” whether the agents given these powers are to act together or separately. (f) GRANT OF AUTHORITY: To

11、 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 g

12、rant authority to my agent(s) with respect to the following subjects as defined in sections 51502A through 5-l502N of the New York General Obligations Law: () (A) real estate transactions; () (B) chattel and goods transactions; () (C) bond, share, and commodity transactions; () (D) banking transacti

13、ons; () (E) business operating transactions; () (F) insurance transactions; () (G) estate transactions; () (H) claims and litigation; () (I) personal and family maintenance; () (J) benefits from governmental programs or civil or military service; () (K) health care billing and payment matters; recor

14、ds, 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 identifi

15、ed by the following letters . You need not initial the other lines if you initial line (P). (g) MODIFICATIONS: (OPTIONAL) In this section, you may make additional provisions, including language to limit or supplement authority granted to your agent. However, you cannot use this Modifications section

16、 to grant your agent authority to make major gifts or changes to interests in your property. If you wish to grant your agent such authority, you MUST complete the Statutory Major Gifts Rider. (h) MAJOR GIFTS AND OTHER TRANSFERS: STATUTORY MAJOR GIFTS RIDER: (OPTIONAL) In order to authorize your agen

17、t to make major gifts and other transfers of your property, you must initial the statement below and execute a Statutory Major Gifts Rider at the same time as this instrument. Initialing the statement below by itself does not authorize your agent to make major gifts and other transfers. The preparat

18、ion of the Statutory Major Gifts Rider should be supervised by a lawyer. () (SMGR) I grant my agent authority to make major gifts and other transfers of my property, in accordance with the terms and conditions of the Statutory Major Gifts Rider that supplements this Power of Attorney.(i) DESIGNATION

19、 OF MONITOR(S): (OPTIONAL) 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 s

20、uch transactions shall provide the records to the monitor(s) upon request. (j) COMPENSATION OF AGENT(S): (OPTIONAL) 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

21、 rendered on your behalf, initial the statement below. If you wish to define “reasonable compensation”, you may do so above, under “Modifications.” () My agent(s) shall be entitled to reasonable compensation for services rendered. (k) ACCEPTANCE BY THIRD PARTIES: I agree to indemnify the third party

22、 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

23、 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 y

24、ou 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 signs here: _ State of New York County of ss.: On the day of in the year before me, the undersigned, pers

25、onally 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 signat

26、ure(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. _Signature and Office of individual taking acknowledgment(n) IMPORTANT INFORMATION FOR THE AGENT: When you accept the authority granted under this Power of Attorney, a sp

27、ecial 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 inst

28、ructions, in the principals best interest; (2) avoid conflicts that would impair your ability to act in the principals best interest; (3) keep the principals property separate and distinct from any assets you own or control, unless otherwise permitted by law; (4) keep a record or all receipts, payme

29、nts, 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 principals name and signing your own name as “agent” in either of the following manner: (Principals Name) by (Your Signature) as Agent, or (Your

30、 Signature) as Agent for (Principals Name). You may not use the principals assets to benefit yourself or give major gifts to yourself or anyone else unless the principal has specifically granted you that authority in this Power of Attorney or in a Statutory Major Gifts Rider attached to this Power o

31、f 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 principals 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

32、in this document, or the principals 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 Yorks General Obligation

33、s 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. (o) AGENTS SIGNATURE AND ACKNOWLEDGMENT OF APPOINTMENT: It is not required that the principal and the

34、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. Agent(s) sign(s) here: _ _State

35、 of New York County of ss.: On the day of in the year before me, the undersigned, 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/t

36、hey 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. _Signature and Office of individual taking acknowledgmentState of New York County of

37、 ss.: On the day of in the year before me, the undersigned, 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

38、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. _Signature and Office of individual taking acknowledgmentRETURN BY MAIL TO:NEW YORK STATUTORY POWER OF ATT

39、ORNEYAFFIDAVIT AS TO POWER OF ATTORNEY STATE OF COUNTY OF ss: , being duly sworn, deposes and says as follows: 1. This affidavit is made in connection with the (transfer)(mortgage) of property known as , in , New York to . 2. I am (the)(an) agent named in the Power of Attorney (hereafter Power of At

40、torney) made by , as principal (the Principal), dated . 3. I do not have actual notice that the Power of Attorney has been modified in any way that would affect my ability to authorize or engage in the present transaction for which the Power of Attorney is being used, or notice of any facts indicati

41、ng that the Power of Attorney has been so modified. 4. I do not have actual notice of the termination or revocation of the Power of Attorney, or notice of any facts indicating that the Power of Attorney has been terminated or revoked, and the Power of Attorney remains in full force and effect. 5. If

42、 the Principal has been my spouse, we are not divorced and our marriage has not been annulled. 6. If I am a successor agent, the prior agent is no longer able or willing to serve. _Sworn to before me this day of , 20. _Notary Public NOTE: If multiple agents are appointed, an affidavit is to be execu

43、ted by each agent.POWER OF ATTORNEYNEW YORK STATUTORY MAJOR GIFTS RIDERAUTHORIZATION TO MAKE MAJOR GIFTS OR OTHER TRANSFERSAttached to a New York Statutory Short Form Power of Attorneydated made by CAUTION TO THE PRINCIPAL: This OPTIONAL rider allows you to authorize your agent to make major gifts o

44、r other transfers of your money or other property during your lifetime. Granting any of the following authority to your agent gives your agent the authority to take actions which could significantly reduce your property or change how your property is distributed at your death. “Major gifts or other

45、transfers” are described in section 5-1514 of the General Obligations Law. This Major Gifts Rider does not require your agent to exercise granted authority, but when he or she exercises this authority, he or she must act according to any instructions you provide, or otherwise in your best interest.

46、This Major Gifts Rider and the Power of Attorney it supplements must be read together as a single instrument. Before signing this document authorizing your agent to make major gifts and other transfers, you should seek legal advice to ensure that your intentions are clearly and properly expressed. (

47、a) GRANT OF LIMITED AUTHORITY TO MAKE GIFTS: Granting gifting authority to your agent gives your agent the authority to take actions which could significantly reduce your property. If you wish to allow your agent to make gifts to himself or herself, you must separately grant that authority in subdiv

48、ision (c) below. To grant your agent the gifting authority provided below, initial the bracket to the left of the authority. () I grant authority to my agent to make gifts to my spouse, children and more remote descendants, and parents, not to exceed, for each donee, the annual federal gift tax excl

49、usion amount pursuant to the Internal Revenue Code. For gifts to my children and more remote descendants, and parents, the maximum amount of the gift to each donee shall not exceed twice the gift tax exclusion amount, if my spouse agrees to split gift treatment pursuant to the Internal Revenue Code.

50、 This authority must be exercised pursuant to my instructions, or otherwise for purposes which the agent reasonably deems to be in my best interest.(b) MODIFICATIONS: Use this section if you wish to authorize gifts in excess of the above amount, gifts to other beneficiaries or other types of transfe

51、rs. 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. If you wish to authorize your agent to make gifts or transfers to himself or herself, you must separat

52、ely grant that authority in subdivision (c) below. () I grant the following authority to my agent to make gifts or transfers pursuant to my instructions, or otherwise for purposes which the agent reasonably deems to be in my best interest. (c) GRANT OF SPECIFIC AUTHORITY FOR AN AGENT TO MAKE MAJOR G

53、IFTS OR OTHER TRANSFERS TO HIMSELF OR HERSELF: (OPTIONAL) If you wish to authorize your agent to make gifts or transfers to himself or herself, you must grant that authority in this section, indicating to which agent(s) the authorization is granted, and any limitations and guidelines. () I grant spe

54、cific authority for the following agent(s) to make the following major gifts or other transfers to himself or herself: This authority must be exercised pursuant to my instructions, or otherwise for purposes which the agent reasonably deems to be in my best interest. (d) ACCEPTANCE BY THIRD PARTIES:

55、I agree to indemnify the third party for any claims that may arise against the third party because of reliance on this Major Gifts Rider. (e) SIGNATURE OF PRINCIPAL AND ACKNOWLEDGMENT: In Witness Whereof I have hereunto signed my name on , 20. PRINCIPAL signs here: _State of New York County of ss.:

56、On the day of in the year before me, the undersigned, 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

57、/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. _Signature and Office of individual taking acknowledgment(f) SIGNATURES OF WITNESSES: By signing as a witness, I

58、 acknowledge that the principal signed the Major Gifts Rider in my presence and the presence of the other witness, or that the principal acknowledged to me that the principals signature was affixed by him or her or at his or her direction. I also acknowledge that the principal has stated that this M

59、ajor Gifts Rider reflects his or her wishes and that he or she has signed it voluntarily. I am not named herein as a permissible recipient of major gifts. Signature of witness 1Signature of witness 2DateDatePrint NamePrint NameAddressAddressCity, State, Zip codeCity, State, Zip code(g) THIS DOCUMENT PREPARED BY: