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 the Nebraska Uniform Power of
Attorney Act.
NEBRASKA
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 Nebraska Uniform Power
of Attorney Act.
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 yo
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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 the Nebraska Uniform Power of
Attorney Act.
NEBRASKA
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 Nebraska Uniform Power
of Attorney Act.
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.
This
form will not revoke a power of attorney previously executed by you unless
you add that the previous power of attorney is revoked or that all other powers
of attorney are revoked by this power of attorney.
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: ..............
Release
of Information
I
agree to, authorize, and allow full release of information, by any governmental
agency, business, creditor, or third party who may have information pertaining
to my assets or income, to my agent named herein.
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 Nebraska Uniform Power of Attorney Act:
(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 Nebraska Uniform Power of Attorney Act and any special instructions in
this power of attorney
(.....)
Create or change rights of survivorship
(.....) Create or change a beneficiary designation
(.....) Delegate to 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
(.....)
Renounce or disclaim an interest in property, including a power of appointment
LIMITATION ON AGENT'S
AUTHORITY
Except
as otherwise authorized by the Power of Personal and Family Maintenance, an
agent 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 or the Grant of Specific Authority.
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 or guardian] of
my estate or [guardian] of my person, I nominate the following person(s) for
appointment:
Name
of Nominee for [conservator or guardian] 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
being fully accomplished; or
5. if you are married to the principal, a legal action
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 Nebraska Uniform Power of Attorney Act. If you violate the Nebraska
Uniform Power of Attorney Act 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.
OPTIONAL
SIGNATURE OF AGENT
I
HAVE READ AND ACCEPT THE DUTIES AND LIABILITIES OF THE AGENT AS SPECIFIED
IN THIS POWER OF ATTORNEY
Agent's
Signature: .....................................
Date: ..................................................