UNIFORM  STATUTORY FORM  POWER OF ATTORNEY

 

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, INCLUSIVE). 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 IF YOU LATER WISH TO DO SO.
 
I,______________________________________________________________, of
(address)__________________________________________________________
hereby appoint __________________________________________________, of
(address)__________________________________________________________
 
as my agent and 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 IN FRONT OF (N) AND IGNORE THE LINES IN FRONT OF 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.

(G) _____    Insurance and annuity 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.
 
______This power of attorney shall become effective upon my incapcitation

or
 
______This power of attorney shall not be affected by my subsequent incapacity
 

UNLESS YOU DIRECT OTHERWISE ABOVE THIS POWER OF ATTORNEY IS EFFECTIVE IMMEDIATELY AND WILL CONTINUE UNTIL IT IS REVOKED.
 
 
EXERCISE OF POWER OF ATTORNEY WHERE MORE THAN ONE AGENT DESIGNATED
 
If I have designated more than one agent, the agents are to act separately or jointly.
 

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 effective as to a third party until the third party has actual knowledge of the revocation. I agree to indemnify the third party for the claims that arise against the third party because of reliance on this power of attorney.

 
Signed__________________________________________________
 
On ______________, 200___
 
(Social Security Number)  ______________________
 

BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES OF AN AGENT.
 
State of _______________County of ___________________________                                
 
On_______ before me, __________________________________ personally appeared
 
_______________________________________ personally known to me
 
 OR -
 
______________________________________ proved to me on the basis of satisfactory
evidence to be the person(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 authorized capacity(ties), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the same.       
 

CAPACITY CLAIMED BY SIGNER

_____ Individual

_____ Corporate Officer

_____ Limited Partner

_____ General Partner

_____ Attorney-in-Fact

_____ Trustee(s)

_____ Guardian/Conservator

_____ Other________________________________________

Signer Represents__________________________________

WITNESS my hand and official seal.
_____________________________________________________________________________
     

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