A document substantially in
the following form may be used to create a statutory form power of attorney that
has the meaning and effect prescribed by this part 7.
STATE OF COLORADO STATUTORY FORM
POWER OF ATTORNEY
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 coagent in the special instructions. Coagents 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: _____________________________
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.)
(__)
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, including
powers to participate in the designation or changing of a fiduciary and powers to
participate in the direction of a fiduciary in the exercise of the fiduciary's powers
(__)
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
partnership, 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.
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 ________________________
[County] of ________________________
This document was acknowledged before me on ________________________,
(Date)
by ________________________.
(Name of principal)
__________________________ (Seal, if any)
Signature of notary
My commission expires: ________________________
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
(6)
Attempt to preserve the principal's estate plan if you know the plan and preserving
the plan is consistent with the principal's best interest.
Termination of agent's authority
You must stop acting on behalf of the principal if you learn of any event that
terminates this power of attorney or your authority under this power of attorney.
Events that terminate a power of attorney or your authority to act under a power of
attorney include:
(1)
Death of the principal;
(2)
The principal's revocation of the power of attorney or your authority;
(3)
The occurrence of a termination event stated in the power of attorney;
(4)
The purpose of the power of attorney is fully accomplished; or
(5)
If you are married to the principal, a legal action is filed with a court to end your
marriage, or for your legal separation, unless the special instructions in this power
of attorney state that such an action will not terminate your authority.
Liability of agent
The meaning of the authority granted to you is defined in the Uniform Power of
Attorney Act, part 7 of article 14 of title 15, Colorado Revised Statutes. If you
violate the Uniform Power of Attorney Act, part 7 of article 14 of title 15, Colorado
Revised Statutes, or act outside the authority granted, you may be liable for any
damages caused by your violation.
If there is anything about this document or your duties that you do not understand,
you should seek legal advice.