§ 5-1513 — Statutory short form power of attorney

§ 5-1513. Statutory short form power of attorney. The use of the\nfollowing form, or one which substantially conforms to the following\nform, in the creation of a power of attorney is lawful, and, when used,\nand executed in accordance with subdivision one of section 5-1501B of\nthis title, it shall be construed as a statutory short form power of\nattorney in accordance with the provisions of this title; provided\nhowever, that any section indicated as "Optional" which is not used may\nbe omitted and replaced by the words "Intentionally Omitted":\n "POWER OF ATTORNEY NEW YORK STATUTORY SHORT FORM\n (a) CAUTION TO THE PRINCIPAL: Your Power of Attorney is an important\ndocument. As the "principal," you give the person whom you choose (your\n"agent") authority to spend your money and sell or dispose of your\nproperty during your lifetime without telling you. You do not lose your\nauthority to act even though you have given your agent similar\nauthority.\n When your agent exercises this authority, he or she must act according\nto any instructions you have provided or, where there are no specific\ninstructions, in your best interest. "Important Information for the\nAgent" at the end of this document describes your agent's\nresponsibilities.\n Your agent can act on your behalf only after signing the Power of\nAttorney before a notary public.\n You can request information from your agent at any time. If you are\nrevoking a prior Power of Attorney, you should provide written notice of\nthe revocation to your prior agent(s) and to any third parties who may\nhave acted upon it, including the financial institutions where your\naccounts are located.\n You can revoke or terminate your Power of Attorney at any time for any\nreason as long as you are of sound mind. If you are no longer of sound\nmind, a court can remove an agent for acting improperly.\n Your agent cannot make health care decisions for you. You may execute\na "Health Care Proxy" to do this.\n The law governing Powers of Attorney is contained in the New York\nGeneral Obligations Law, Article 5, Title 15. This law is available at a\nlaw library, or online through the New York State Senate or Assembly\nwebsites, www.nysenate.gov or www.nyassembly.gov.\n If there is anything about this document that you do not understand,\nyou should ask a lawyer of your own choosing to explain it to you.\n(b) DESIGNATION OF AGENT(S):\nI, _______________________________________________, hereby appoint:\n name and address of principal\n_____________________________________________________as my agent(s)\n name(s) and address(es) of agent(s)\n If you designate more than one agent above and you do not initial the\nstatement below, they must act together.\n ( ) My agents may act SEPARATELY.\n(c) DESIGNATION OF SUCCESSOR AGENT(S): (OPTIONAL)\n If any agent designated above is unable or unwilling to serve, I\nappoint as my successor agent(s):\n _______________________________________________________________\n name(s) and address(es) of successor agent(s)\n If you do not initial the statement below, successor agents designated\nabove must act together.\n ( ) My successor agents may act SEPARATELY.\n You may provide for specific succession rules in this section. Insert\nspecific succession provisions here:\n(d) This POWER OF ATTORNEY shall not be affected by my subsequent\nincapacity unless I have stated otherwise below, under "Modifications".\n(e) This POWER OF ATTORNEY DOES NOT REVOKE any Powers of Attorney\npreviously executed by me unless I have stated otherwise below, under\n"Modifications."\n(f) GRANT OF AUTHORITY:\n To grant your agent some or all of the authority below, either\n (1) Initial the bracket at each authority you grant, or\n (2) Write or type the letters for each authority you grant on the\n blank line at (P), and initial the bracket at (P). If you initial\n (P), you do not need to initial the other lines.\n I grant authority to my agent(s) with respect to the following\n subjects as defined in sections 5-1502A through 5-1502N of the New\n York General Obligations Law:\n ( ) (A) real estate transactions;\n ( ) (B) chattel and goods transactions;\n ( ) (C) bond, share, and commodity transactions;\n ( ) (D) banking transactions;\n ( ) (E) business operating transactions;\n ( ) (F) insurance transactions;\n ( ) (G) estate transactions;\n ( ) (H) claims and litigation;\n ( ) (I) personal and family maintenance. If you grant your agent\n this authority, it will allow the agent to make gifts that you\n customarily have made to individuals, including the agent, and\n charitable organizations. The total amount of all such gifts in\n any one calendar year cannot exceed five thousand dollars;\n ( ) (J) benefits from governmental programs or civil or military\n service;\n ( )(K) financial matters related to health care; records, reports,\n and statements;\n ( )(L) retirement benefit transactions;\n ( )(M) tax matters;\n ( )(N) all other matters;\n ( )(O) full and unqualified authority to my agent(s) to delegate\n any or all of the foregoing powers to any person or persons whom\n my agent(s) select;\n ( )(P) EACH of the matters identified by the following\n letters______.\nYou need not initial the other lines if you initial line (P).\n(g) CERTAIN GIFT TRANSACTIONS: (OPTIONAL)\n In order to authorize your agent to make gifts in excess of an annual\ntotal of $5,000 for all gifts described in (I) of the grant of authority\nsection of this document (under personal and family maintenance), and/or\nto make changes to interest in your property, you must expressly grant\nthat authorization in the Modifications section below. If you wish to\nauthorize your agent to make gifts to himself or herself, you must\nexpressly grant such authorization in the Modifications section below.\nGranting such authority to your agent gives your agent the authority to\ntake actions which could significantly reduce your property and/or\nchange how your property is distributed at your death. Your choice to\ngrant such authority should be discussed with a lawyer.\n ( ) I grant my agent authority to make gifts in accordance with the\nterms and conditions of the Modifications that supplement this Statutory\nPower of Attorney.\n (h) MODIFICATIONS: (OPTIONAL)\n In this section, you may make additional provisions, including, but\nnot limited to, language to limit or supplement authority granted to\nyour agent, language to grant your agent the specific authority to make\ngifts to himself or herself, and/or language to grant your agent the\nspecific authority to make other gift transactions and/or changes to\ninterests in your property. Your agent is entitled to be reimbursed from\nyour assets for reasonable expenses incurred on your behalf. In this\nsection, you may make additional provisions if you ALSO wish your\nagent(s) to be compensated from your assets for services rendered on\nyour behalf, and you may define "reasonable compensation."\n(i) DESIGNATION OF MONITOR(S): (OPTIONAL)\n If you wish to appoint monitor(s), initial and fill in the section\nbelow:\n ( ) I wish to designate ______________________, whose address(es) is\n(are) ____________________________________________________________, as\nmonitor(s). Upon the request of the monitor(s), my agent(s) must provide\nthe monitor(s) with a copy of the power of attorney and a record of all\ntransactions done or made on my behalf. Third parties holding records of\nsuch transactions shall provide the records to the monitor(s) upon\nrequest.\n(j) COMPENSATION OF AGENT(S):\n Your agent is entitled to be reimbursed from your assets for\nreasonable expenses incurred on your behalf. If you ALSO wish your\nagent(s) to be compensated from your assets for services rendered on\nyour behalf, and/or you wish to define "reasonable compensation", you\nmay do so above, under "Modifications".\n(k) ACCEPTANCE BY THIRD PARTIES: I agree to indemnify the third party\nfor any claims that may arise against the third party because of\nreliance on this Power of Attorney. I understand that any termination of\nthis Power of Attorney, whether the result of my revocation of the Power\nof Attorney or otherwise, is not effective as to a third party until the\nthird party has actual notice or knowledge of the termination.\n(l) TERMINATION: This Power of Attorney continues until I revoke it or\nit is terminated by my death or other event described in section 5-1511\nof the General Obligations Law.\n Section 5-1511 of the General Obligations Law describes the manner in\nwhich you may revoke your Power of Attorney, and the events which\nterminate the Power of Attorney.\n(m) SIGNATURE AND ACKNOWLEDGMENT: In Witness Whereof I have hereunto\nsigned my name on ___________,20___.\nPRINCIPAL signs here: ==>__________________________________________\n(acknowledgment)\n(n) SIGNATURES OF WITNESSES:\n By signing as a witness, I acknowledge that the principal signed the\nPower of Attorney in my presence and in the presence of the other\nwitness, or that the principal acknowledged to me that the principal's\nsignature was affixed by him or her or at his or her direction. I also\nacknowledge that the principal has stated that this Power of Attorney\nreflects his or her wishes and that he or she has signed it voluntarily.\nI am not named herein as an agent or as a permissible recipient of\ngifts.\n_____________________________________________________________\nSignature of Witness 1 Signature of Witness 2\n____________________________________________________________\nDate Date\n____________________________________________________________\nPrint name Print name\n____________________________________________________________\nAddress Address\n____________________________________________________________\nCity, State, Zip Code City, State, Zip Code\n (o) IMPORTANT INFORMATION FOR THE AGENT:\n When you accept the authority granted under this Power of Attorney, a\nspecial legal relationship is created between you and the principal.\nThis relationship imposes on you legal responsibilities that continue\nuntil you resign or the Power of Attorney is terminated or revoked. You\nmust:\n (1) act according to any instructions from the principal, or, where\nthere are no instructions, in the principal's best interest;\n (2) avoid conflicts that would impair your ability to act in the\nprincipal's best interest;\n (3) keep the principal's property separate and distinct from any\nassets you own or control, unless otherwise permitted by law;\n (4) keep a record of all transactions conducted for the principal or\nkeep all receipts of payments and transactions conducted for the\nprincipal; and\n (5) disclose your identity as an agent whenever you act for the\nprincipal by writing or printing the principal's name and signing your\nown name as "agent" in either of the following manners: (Principal's\nName) by (Your Signature) as Agent, or (your signature) as Agent for\n(Principal's Name).\n You may not use the principal's assets to benefit yourself or anyone\nelse or make gifts to yourself or anyone else unless the principal has\nspecifically granted you that authority in the modifications section of\nthis document or a Non-Statutory Power of Attorney. If you have that\nauthority, you must act according to any instructions of the principal\nor, where there are no such instructions, in the principal's best\ninterest. You may resign by giving written notice to the principal and\nto any co-agent, successor agent, monitor if one has been named in this\ndocument, or the principal's guardian if one has been appointed. If\nthere is anything about this document or your responsibilities that you\ndo not understand, you should seek legal advice.\n Liability of agent:\n The meaning of the authority given to you is defined in New York's\nGeneral Obligations Law, Article 5, Title 15. If it is found that you\nhave violated the law or acted outside the authority granted to you in\nthe Power of Attorney, you may be liable under the law for your\nviolation.\n(p) AGENT'S SIGNATURE AND ACKNOWLEDGMENT OF APPOINTMENT:\n It is not required that the principal and the agent(s) sign at the\nsame time, nor that multiple agents sign at the same time.\nI/we, ___________________________________________, have read the\nforegoing Power of Attorney. I am/we are the person(s) identified\ntherein as agent(s) for the principal named therein.\nI/we acknowledge my/our legal responsibilities.\nIn Witness Whereof I have hereunto signed my name on ________________\n20_____.\nAgent(s) sign(s) here:==>__________________________________________\n(acknowledgment(s))\n(q) SUCCESSOR AGENT'S SIGNATURE AND ACKNOWLEDGMENT OF APPOINTMENT:\n It is not required that the principal and the SUCCESSOR agent(s), if\nany, sign at the same time, nor that multiple SUCCESSOR agents sign at\nthe same time. Furthermore, successor agents can not use this power of\nattorney unless the agent(s) designated above is/are unable or unwilling\nto serve.\nI/we, ___________________________________________, have read the\nforegoing Power of Attorney. I am/we are the person(s) identified\ntherein as SUCCESSOR agent(s) for the principal named therein.\nIn Witness Whereof I have hereunto signed my name on ________________\n20_____.\nSuccessor Agent(s) sign(s) here:==>______________________________________\n(acknowledgment(s))"\n