"Power of Attorney Form" - Colorado

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STATE OF COLORADO STATUTORY FORM
POWER OF ATTORNEY
(effective January 1, 2010)
IMPORTANT INFORMATION
This power of attorney authorizes another person (your agent) to make decisions
concerning your property for you (the principal). Your agent will be able to make decisions and act
with respect to your property (including your money) whether or not you are able to act for yourself.
The meaning of authority over subjects listed on this form is explained in the Uniform Power of
Attorney Act, part 7 of article 14 of title 15, Colorado Revised Statutes.
This power of attorney does not authorize the agent to make health care decisions for you.
You should select someone you trust to serve as your agent. Unless you specify otherwise,
generally the agent's authority will continue until you die or revoke the power of attorney or the
agent resigns or is unable to act for you.
Your agent is entitled to reasonable compensation unless you state otherwise in the special
instructions.
This form provides for designation of one agent. If you wish to name more than one agent
you may name a co-agent in the special instructions. Co-agents are not required to act together
unless you include that requirement in the special instructions.
If your agent is unable or unwilling to act for you, your power of attorney will end unless you
have named a successor agent. You may also name a second successor agent.
This power of attorney becomes effective immediately unless you state otherwise in the
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 of principal) name the following person as
my agent:
Name of agent:
Agent's address:
Agent's telephone number:
STATE OF COLORADO STATUTORY FORM POWER OF ATTORNEY
Page 1 of 6
STATE OF COLORADO STATUTORY FORM
POWER OF ATTORNEY
(effective January 1, 2010)
IMPORTANT INFORMATION
This power of attorney authorizes another person (your agent) to make decisions
concerning your property for you (the principal). Your agent will be able to make decisions and act
with respect to your property (including your money) whether or not you are able to act for yourself.
The meaning of authority over subjects listed on this form is explained in the Uniform Power of
Attorney Act, part 7 of article 14 of title 15, Colorado Revised Statutes.
This power of attorney does not authorize the agent to make health care decisions for you.
You should select someone you trust to serve as your agent. Unless you specify otherwise,
generally the agent's authority will continue until you die or revoke the power of attorney or the
agent resigns or is unable to act for you.
Your agent is entitled to reasonable compensation unless you state otherwise in the special
instructions.
This form provides for designation of one agent. If you wish to name more than one agent
you may name a co-agent in the special instructions. Co-agents are not required to act together
unless you include that requirement in the special instructions.
If your agent is unable or unwilling to act for you, your power of attorney will end unless you
have named a successor agent. You may also name a second successor agent.
This power of attorney becomes effective immediately unless you state otherwise in the
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 of principal) name the following person as
my agent:
Name of agent:
Agent's address:
Agent's telephone number:
STATE OF COLORADO STATUTORY FORM POWER OF ATTORNEY
Page 1 of 6
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 unable or unwilling 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, part 7 of article 14 of title 15,
Colorado Revised Statutes:
(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.)
STATE OF COLORADO STATUTORY FORM POWER OF ATTORNEY
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(___) Create, amend, revoke, or terminate an inter vivos trust
(___) Make a gift, subject to the limitations of the Uniform Power of Attorney Act set forth
in section 15-14-740, Colorado Revised Statutes, 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
(___) Disclaim, refuse, or release an interest in property or a power of appointment
(___) Exercise a power of appointment other than: (1) The exercise of a general power of
appointment for the benefit of the principal which may, if the subject of estates,
trusts, and other beneficial interests is authorized above, be exercised as provided
under the subject of estates, trusts, and other beneficial interests; or (2) the exercise
of a general power of appointment for the benefit of persons other than the principal
which may, if the making of a gift is specifically authorized above, be exercised
under the specific authorization to make gifts
(___) Exercise powers, rights, or authority as a partner, member, or manager of a partner-
ship, limited liability company, or other entity that the principal may exercise on
behalf of the entity and has authority to delegate excluding the exercise of such
powers, rights, and authority with respect to an entity owned solely by the principal
which may, if operation of entity or business is authorized above, be exercised as
provided under the subject of operation of the entity or business
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.
STATE OF COLORADO STATUTORY FORM POWER OF ATTORNEY
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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 COLORADO STATUTORY FORM POWER OF ATTORNEY
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STATE OF COLORADO
)
) ss.
___________ COUNTY OF _________
)
The foregoing instrument was acknowledged before me this ____ day of ____________,
20___, by _____________________________________, principal.
Witness my hand and official seal.
My commission expires: ________________.
Notary Public
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
STATE OF COLORADO STATUTORY FORM POWER OF ATTORNEY
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