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1、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 or dispose of your property during your lifetime without tellin
2、g 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 specific instructions, in your best interest. “Important Informati
3、on 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 time. If you are revoking a prior Power of Attorney by executing
4、 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 reason as long as you are of sound mind. If you are no longer
5、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 General Obligations Law, Article 5, Title 15. This law is availa
6、ble 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 your own choosing to explain it to you. (b) DESIGNATION OF AGENT
7、(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 SEPARATELY. (c) DESIGNATION OF SUCCESSOR AGENT(S): (OPTIONAL) If ever
8、y 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 successor agents may act SEPARATELY. (d) This POWER OF ATTORNE
9、Y 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, under “Modifications.” If you are NOT revoking your prior Power
10、s 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 grant your agent some or all of the authority below, either (1
11、) 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 sub
12、jects 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 transactions; () (E) business operating transactions; () (F) insurance t
13、ransactions; () (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; records, reports, and statements; () (L) retirement benefit transact
14、ions; () (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 li
15、nes 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 to grant your agent authority to make major gifts or changes t
16、o 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 agent to make major gifts and other transfers of your property, you
17、 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 preparation of the Statutory Major Gifts Rider should be supervised by
18、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 OF MONITOR(S): (OPTIONAL) I wish to designate , whose address(
19、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) up
20、on 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 rendered on your behalf, initial the statement below. If you w
21、ish 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 for any claims that may arise against the third party because
22、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
23、: 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 term
24、inate 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, personally appeared , personally known to me or proved to me on the
25、 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
26、 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 special legal relationship is created between you and the princip
27、al. 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 principals best interest; (2) avoid conflicts
28、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, payments, and transactions conducted for the principal; and (5) disc
29、lose 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 Signature) as Agent for (Principals Name). You may not use the
30、 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 of Attorney. If you have that authority, you must act according
31、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 in this document, or the principals guardian if one has been ap
32、pointed. 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 Obligations Law, Article 5, Title 15. If it is found that you have violat
33、ed 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 agent(s) sign at the same time, nor that multiple agents sign a
34、t 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 of New York County of ss.: On the day of in the year before me
35、, 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/her/their capacity(ies), and that
36、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 ss.: On the day of in the year before me, the undersigned, per
37、sonally 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 signa
38、ture(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 ATTORNEYAFFIDAVIT AS TO POWER OF ATTORNEY STATE OF COUNTY OF ss: ,
39、 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 Attorney) made by , as principal (the Principal), dated . 3. I do
40、 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 indicating that the Power of Attorney has been so modified. 4. I do not
41、 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 the Principal has been my spouse, we are not divorced and our
42、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 executed by each agent.POWER OF ATTORNEYNEW YORK STATUTORY MAJOR GIF
43、TS 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 or other transfers of your money or other property during your l
44、ifetime. 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 transfers” are described in section 5-1514 of the General Oblig
45、ations 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. This Major Gifts Rider and the Power of Attorney it supplements
46、 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. (a) GRANT OF LIMITED AUTHORITY TO MAKE GIFTS: Granting gifting a
47、uthority 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 subdivision (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 m
