§633B.301, POWERS OF ATTORNEY 20
SUBCHAPTER III
FORMS
633B.301 Power of attorney — form.
A document substantially in the following form may be used to create a statutory power of
attorney that has the meaning and effect prescribed by this chapter:
IOWA STATUTORY POWER OF ATTORNEY FORM
1.POWER OF ATTORNEY
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 but not limited to 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 Iowa Uniform Power
of Attorney Act, Iowa Code chapter 633B.
This power of attorney does not authorize the agent t
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§633B.301, POWERS OF ATTORNEY 20
SUBCHAPTER III
FORMS
633B.301 Power of attorney — form.
A document substantially in the following form may be used to create a statutory power of
attorney that has the meaning and effect prescribed by this chapter:
IOWA STATUTORY POWER OF ATTORNEY FORM
1. POWER OF ATTORNEY
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 but not limited to 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 Iowa Uniform Power
of Attorney Act, Iowa Code chapter 633B.
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 not entitled to compensation unless you state
otherwise in the optional 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 optional
Special Instructions. Coagents must act by majority rule unless you
provide otherwise in the optional 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 upon
signature and acknowledgment unless you state otherwise in the
optional Special Instructions.
If you have questions about this 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 _______________________
Ifmysuccessoragentisunableorunwillingtoactforme, Iname
as my second successor agent:
Name of Second Successor Agent ___________________________
Second Successor Agent’s Address _________________________
Second Successor Agent’s Telephone Number ________________
21 POWERS OF ATTORNEY, §633B.301
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
Iowa Uniform Power of Attorney Act, Iowa Code chapter 633B:
(Initial each subject you want to include in the agent’s general
authority. If you wish to grant general authority over all of the
subjectsyoumayinitial“AllPrecedingSubjects”insteadofinitialing
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 shall 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.)
___ Amend, revoke, or terminate a revocable inter vivos trust, if
authorized by the trust.
___ Agree to the amendment or termination of any other inter
vivos trust.
___ Make a gift to an individual who is not an agent, subject to
the limitations of the Iowa Uniform Power of Attorney Act, Iowa
Code section 633B.217, and any special instructions in this power
of attorney.
Make gifts, either direct or indirect, to my agent acting under
this power of attorney as follows:
___ Any such gift must be approved in writing by
________________; or
___ No third-party approval is needed.
___ 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 or refuse an interest in property, including a power
of appointment.
§633B.301, POWERS OF ATTORNEY 22
LIMITATION ON AGENT’S AUTHORITY
An agent that is not my ancestor, spouse, or descendant shall 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 optional Special Instructions.
SPECIAL INSTRUCTIONS (OPTIONAL)
You may give special instructions on the following lines:
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
_________________________ shall have the authority to request an
accounting of any agent.
EFFECTIVE DATE
This power of attorney is effective immediately upon signature
and acknowledgment unless I have stated otherwise in the optional
Special Instructions.
NOMINATION OF CONSERVATOR AND GUARDIAN
(OPTIONAL)
Ifitbecomesnecessaryforacourttoappointaconservatorofmy
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
23 POWERS OF ATTORNEY, §633B.301
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
___________________________________________________________
___________________________________________________________
2. 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 the
principal and you. This relationship imposes upon you legal duties
that continue until you resign or the power of attorney is terminated
or revoked. You must do all of the following:
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.
Act in good faith.
Do nothing beyond the authority granted in this power of
attorney.
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 do all of the following:
Act loyally for the principal’s benefit.
Avoid conflicts that would impair your ability to act in the
principal’s best interest.
Act with care, competence, and diligence.
Keep a record of all receipts, disbursements, and transactions
made on behalf of the principal.
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.
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
Youmuststopactingonbehalfoftheprincipalifyoulearnofany
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 any of the
following:
Death of the principal.
The principal’s revocation of the power of attorney or your
authority.
The occurrence of a termination event stated in the power of
attorney.
The purpose of the power of attorney is fully accomplished.
§633B.301, POWERS OF ATTORNEY 24
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
Iowa Uniform Power of Attorney Act, Iowa Code chapter 633B. If
you violate the Iowa Uniform Power of Attorney Act, Iowa Code
chapter633B,oractoutsidetheauthoritygranted,youmaybeliable
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.