UNIFORM STATUTORY FORM POWER OF
ATTORNEY
(California Probate Code Section 4401)
NOTICE: THE POWERS GRANTED BY THIS DOCUMENT
ARE BROAD AND SWEEPING. THEY ARE EXPLAINED IN THE UNIFORM STATUTORY FORM POWER
OF ATTORNEY ACT (CALIFORNIA PROBATE CODE SECTIONS 4400-4465). IF YOU HAVE ANY
QUESTIONS ABOUT THESE POWERS, OBTAIN COMPETENT LEGAL ADVICE. THIS DOCUMENT DOES
NOT AUTHORIZE ANYONE TO MAKE MEDICAL AND OTHER HEALTH CARE DECISIONS FOR YOU.
YOU MAY REVOKE THIS POWER OF ATTORNEY LATER IF YOU WISH TO DO SO.
I,
_____________________________________________________ (your name and address)
appoint __________________________________________________________ (name and
address of the person appointed, or of each person appointed if you want to
designate more than one) as my agent (attorney-in-fact) to act for me in any
lawful way with respect to the following initialed subjects:
TO GRANT ALL OF THE FOLLOWING POWERS, INITIAL
THE LINE MARKED WITH A (N) AND IGNORE THE LINES IN FRONT OF THE THE OTHER
POWERS.
TO GRANT ONE OR MORE, BUT FEWER THAN ALL OF THE
FOLLOWING POWERS, INITIAL THE LINE IN FRONT OF EACH POWER YOU ARE
GRANTING.
TO WITHHOLD A POWER, DO NOT INITIAL THE LINE IN
FRONT OF IT. YOU MAY, BUT NEED NOT, CROSS OUT EACH POWER WITHHELD.
INITIAL:
 |
[ ] (A) Real Property
Transactions. |
|
[ ] (B) Tangible Personal Property
Transactions. |
|
[ ] (C) Stock and Bond
Transactions |
|
[ ] (D) Commodity and Option
Transactions. |
|
[ ] (E) Banking and other Financial
Institution Transactions. |
|
[ ] (F) Business Operating
Transactions. |
|
[ ] (H) Estate, Trust, and other
Beneficiary Transactions. |
|
[ ] (I) Claims and Litigation. |
|
[ ] (J) Personal and Family Maintenance.
|
|
[ ] (K) Benefits from Social Security,
Medicare, Medicaid, or other governmental programs, or civil or military service. |
|
[ ] (L) Retirement plan
Transactions. |
|
[ ] (M) Tax matters. |
|
[ ] (N) ALL OF THE POWERS LISTED
ABOVE. |
YOU NEED NOT INITIAL ANY OTHER LINES IF YOU
INITIAL LINE (N).
SPECIAL
INSTRUCTIONS:
ON THE FOLLOWING LINES YOU MAY GIVE
SPECIAL INSTRUCTIONS LIMITING OR EXTENDING THE POWERS GRANTED TO YOUR
AGENT:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
UNLESS YOU DIRECT OTHERWISE ABOVE, THIS
POWER OF ATTORNEY IS EFFECTIVE IMMEDIATELY AND WILL CONTINUE UNTIL IT IS REVOKED
EVEN THOUGH YOU BECOME INCAPACITATED.
This power of attorney will
continue to be effective even though I become incapacitated.
STRIKE THE PRECEDING SENTENCE IF YOU DO NOT WANT
THIS POWER OF ATTORNEY TO CONTINUE IF YOU BECOME INCAPACITATED.
EXERCISE OF POWER OF ATTORNEY
WHERE
MORE THAN ONE AGENT DESIGNATED
If I have designated more than one agent, the agents are to act
___________________________________________
IF YOU APPOINTED MORE THAN ONE AGENT AND YOU
WANT EACH AGENT TO BE ABLE TO ACT ALONE WITHOUT THE OTHER AGENT JOINING, WRITE
THE WORD "SEPARATELY" IN THE BLANK SPACE ABOVE. IF YOU DO NOT INSERT ANY WORD IN
THE BLANK SPACE, OR IF YOU INSERT THE WORD "JOINTLY," THEN ALL OF YOUR AGENTS
MUST ACT OR SIGN TOGETHER.
I agree that any third party who receives a copy
of this document may act under it. Revocation of the power of attorney is not
effect as to a third party until the third party has actual knowledge of
revocation. I agree to indemnify the third party for any claims that arise
against the third party because of reliance on this power of
attorney.
Signed this __________ day of
_______________________, 19________.
____________________________________________
(your signature)
____________________________________________
(your social security number)
BY ACCEPTING OR ACTING UNDER THE APPOINTMENT,
THE AGENT ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES OF AN
AGENT.
CERTIFICATE OF ACKNOWLEDGMENT OF
NOTARY PUBLIC
STATE OF CALIFORNIA
)
COUNTY OF _____________________
)
On _______________________, before me,
________________________________, the undersigned notary public in and for the
State of California, personally appeared
____________________________________, proved to me on the basis of
satisfactory evidence to be the person whose name is subscribed to the within
instrument, and acknowledged to me that he/she executed the same in his/her
authorized capacity, and that by his/her signature on the instrument the person,
or the entity upon behalf of which the person acted, executed the
instrument.
WITNESS my hand and official seal.
_____________________________________
Signature of
Notary Public
My commission expires __________________ |
