"General Durable Power of Attorney Form"

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General Durable Power of Attorney
KNOW ALL MEN BY THESE PRESENTS, that I, (NAME #1), ____________________
__________________ , principal, have made, constituted, and appointed, and by these
presents do make, constitute, and appoint (NAME #2),__________________________
___________________ , as my true and lawful agent for me and in my name, place,
and stead, giving and granting unto my said agent full power and authority to do and
perform all and every act and thing whatsoever requisite and necessary to be done, and
which I could do if personally present, as fully to all intents and purposes as I might or
could do with full power of substitution and revocation, hereby ratifying and confirming
all that my said agent or substitutes shall lawfully do or cause to be done pursuant to
this Power of Attorney specifically by way of illustration and not by way of limitation:
1. To execute, assign, endorse, and otherwise deal in and with all Bills of Exchange
(checks and drafts); to negotiate the same; to secure cash for any such Bills of
Exchange; to withdraw any funds held by me in any form whether in a bank, savings
and loan association, industrial bank or other institute, no matter in what form, whether
a certificate of deposit, savings account, checking account, trust account, escrow
account or otherwise.
2. To sell and convey any and all real estate held by me in whatever form; to secure
the proceeds from the sale of any such real estate; to execute all documents necessary
in connection with the said transfer, including deeds, closing statements, insurance
assignments, escrow account transfer or otherwise to specifically sell and convey any
such real estate.
3. To execute, sign, obligate and enter into any contract or addendum to contract for
the purchase of real estate, wherever located.
4. To enter into any safe deposit box in my name wherever located to remove the
contents or any part of same therefrom specifically to enter into the safe deposit box
and remove the contents or any part therefrom on one or more occasions.
5. To execute any certificates of stock, bonds, mutual funds or securities of any kind or
description for the purpose of sale and conveyance or encumbrance of same, including
the execution of any stock powers or affidavits in connection with such sale, transfer or
encumbrances and specifically to sell, transfer, convey or encumber any security.
6. To sell, transfer, and convey any interest which I might have in any item evidenced
by a certificate of title, including a motor vehicle or vehicles owned by me or by me and
others and specifically to sell and convey any such property.
7. To prepare, execute and file income and other tax returns in all appropriate taxing
jurisdictions; to execute Federal Tax Form 2848 or any power of attorney form required
by the Internal Revenue Service or state authority; to exercise any elections I may have
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General Durable Power of Attorney
KNOW ALL MEN BY THESE PRESENTS, that I, (NAME #1), ____________________
__________________ , principal, have made, constituted, and appointed, and by these
presents do make, constitute, and appoint (NAME #2),__________________________
___________________ , as my true and lawful agent for me and in my name, place,
and stead, giving and granting unto my said agent full power and authority to do and
perform all and every act and thing whatsoever requisite and necessary to be done, and
which I could do if personally present, as fully to all intents and purposes as I might or
could do with full power of substitution and revocation, hereby ratifying and confirming
all that my said agent or substitutes shall lawfully do or cause to be done pursuant to
this Power of Attorney specifically by way of illustration and not by way of limitation:
1. To execute, assign, endorse, and otherwise deal in and with all Bills of Exchange
(checks and drafts); to negotiate the same; to secure cash for any such Bills of
Exchange; to withdraw any funds held by me in any form whether in a bank, savings
and loan association, industrial bank or other institute, no matter in what form, whether
a certificate of deposit, savings account, checking account, trust account, escrow
account or otherwise.
2. To sell and convey any and all real estate held by me in whatever form; to secure
the proceeds from the sale of any such real estate; to execute all documents necessary
in connection with the said transfer, including deeds, closing statements, insurance
assignments, escrow account transfer or otherwise to specifically sell and convey any
such real estate.
3. To execute, sign, obligate and enter into any contract or addendum to contract for
the purchase of real estate, wherever located.
4. To enter into any safe deposit box in my name wherever located to remove the
contents or any part of same therefrom specifically to enter into the safe deposit box
and remove the contents or any part therefrom on one or more occasions.
5. To execute any certificates of stock, bonds, mutual funds or securities of any kind or
description for the purpose of sale and conveyance or encumbrance of same, including
the execution of any stock powers or affidavits in connection with such sale, transfer or
encumbrances and specifically to sell, transfer, convey or encumber any security.
6. To sell, transfer, and convey any interest which I might have in any item evidenced
by a certificate of title, including a motor vehicle or vehicles owned by me or by me and
others and specifically to sell and convey any such property.
7. To prepare, execute and file income and other tax returns in all appropriate taxing
jurisdictions; to execute Federal Tax Form 2848 or any power of attorney form required
by the Internal Revenue Service or state authority; to exercise any elections I may have
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under federal state or local tax law; and generally to represent me in all tax matters and
proceedings of all kinds and for all periods before or after the date of this delegation,
before all offices and officers of the Internal Revenue service, state taxing authority,
and any other taxing body.
8. To transfer all or any part of property owned by me or in which I have an interest to
the trustee of any revocable trust created by me during my lifetime, such that the same
is held and becomes part of the corpus of that trust to be dealt with in accordance with
the terms of that trust.
9. To make gifts, grants or other transfers without consideration, either outright or in
trust to such person(s) (including my agent) or organizations as my agent shall select.
This power shall include the ability of my agent to complete or continue any charitable
contributions previously commenced or contemplated by me.
10. To seek and make application for all public and private benefits to which I may be
entitled, including, but not limited to, Social Security, Medicare, Supplemental Security
Income, Medicaid, Old Age Pension, Veterans’ Administration benefits, and to appeal
or litigate any adverse rulings resulting from such application. The authority granted
herein shall include the power to divest and/or gift assets and resources to my relatives
and friends, including my agent, in order to plan for the receipt of such benefits,
provided that such actions are not unlawful. In addition, in order to qualify me for
governmental benefits, my agent may convert my assets into assets that do not
disqualify me from receiving benefits, and may take any other lawful action deemed
necessary or advisable by my agent to protect such assets from recovery under the
applicable Medicaid regulations or laws.
11. To exercise in any manner any election or option under and to make any one or
more withdrawals from any Individual Retirement Account or any stock option, profit
sharing, pension, thrift, savings or other employee benefit plans in which I may have
any interest, and to become a participant in such a plan or to establish an Individual
Retirement Account in my name, to change the designation of beneficiary in effect for
any such Individual Retirement Account or employee benefit plan, to waive any rights in
which I may have with respect to any employee benefit plan in which my spouse was or
is a participant, to contribute to an existing Individual Retirement Account or other
employee benefit plan in my name, and to roll over the proceeds of a lump-sum
distribution from any qualified pension or profit sharing plan.
This power of Attorney is intended to be valid in any jurisdiction in which it is presented
and for any such jurisdiction to refer to (my state’s) law to interpret and determine the
validity of this document and any of the powers granted under this document. I hereby
authorize the use of a photocopy of this Power of Attorney in lieu of the original copy
executed by me, for purposes of effectuating the terms and provisions hereof.
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In the event (NAME #2) ________________________________________________
shall fail, refuse or be unable to serve as agent, then I appoint (NAME #3), ________
____________________________________________ , to serve as alternate agent.
The above enumeration of powers is set forth as an illustration of this power of my
agent and is not to be construed as a limitation of his/her otherwise general power. Any
institution or person, governmental agency or otherwise, looking to this Power of
Attorney for authority is hereby indemnified and saved harmless by me from any action,
cause of action or right which I might otherwise have by such person, institution or
entities' reliance on the terms of this power.
This durable power of attorney is effective immediately upon the date set forth below.
This general power of attorney is durable. It shall not terminate in the event of my
incapacity and shall survive until my death. It is written and executed in the (my state)
and shall be interpreted in accordance with the laws of that state.
IN WITNESS WHEREOF, I have set my hand and seal this _____ day of __________,
20 ______ .
_____________________________________________
PRINCIPAL
STATE OF
)
) ss.
COUNTY OF
)
The foregoing instrument was acknowledged before me this
day of
, 20
by the Principal named above.
_____________________________________
Notary Public
My commission expires: __________________
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ACCEPTANCE BY AGENT:
The undersigned agent hereby accepts the delegation of authority set out in this
instrument.
Dated this
day of
, 20
.
__________________________________________________
Agent’s Specimen Signature
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