SHORT FORM POWER OF ATTORNEY
WARNING TO PERSON EXECUTING THIS DOCUMENT
This is an important legal document which is authorized by the general laws of this
state. The powers granted by this document are broad and sweeping. They are defined
in §§ 18-16-1 to 18-16-12, both inclusive, of the general laws in chapter 18-16 entitled
"Rhode Island Short Form Power of Attorney Act.�
The use of the short form power of attorney is strictly voluntary, and chapter 18-16
specifically authorizes the use of any other or different form of power of attorney
upon mutual agreement of the parties concerned.
Known All Men by These Presents, which are intended to constitute a GENERAL POWER
OF ATTORNEY pursuant to the Rhode Island Short Form Power of Attorney Act:
That I_______________________________________ (insert name and address of the principal) do hereby appoint_______________________________________ (insert name and address of the agent, or each agent, if more than one is designated)
my attorney(s)-in-fact TO ACT_______________________________________ .
(If more than one agent is designated and the principal wishes each agent alone to
be able to exercise the power conferred, insert in this blank the word "severally�.
Failure to make any insertion or the insertion of the word "jointly� shall require
the agents to act jointly.)
First: In my name, place and stead in any way which I myself could do, if I were personally
present, with respect to the following matters as each of them is defined in the Rhode
Island Statutory Short Form Power of Attorney Act to the extent that I am permitted
by law to act through an agent:
(STRIKE OUT AND INITIAL ON THE OPPOSITE LINE ANY ONE OR MORE OF THE SUBDIVISIONS AS
TO WHICH THE PRINCIPAL DOES NOT DESIRE TO GIVE THE AGENT AUTHORITY. SUCH ELIMINATION
OF ANY ONE OR MORE OF SUBDIVISIONS (A) TO (I), INCLUSIVE, SHALL AUTOMATICALLY CONSTITUTE
AN ELIMINATION ALSO OF SUBDIVISION (J).
To strike out any subdivision the principal must draw a line through the text of that
subdivision AND write his initials in the line opposite.
INITIAL HERE
(A) real state transactions;
(B) chattel and goods transactions;
(C) bond, share and commodity transactions;
(D) banking transactions;
(E) business operating transactions;
(F) insurance transactions;
(G) claims and litigations;
(H) benefits from military service;
(I) records, reports and statements;
(J) all other matters;
_________________________________________
_________________________________________
_________________________________________
(Special provisions and limitations may be included in the statutory short form power
of attorney only if they conform to the requirements of the Rhode Island Statutory
Short Form Power of Attorney Act.)
Second: This power of attorney shall:
(A) be of indefinite duration or
(B) terminate on the following date, _________________________________________ , unless otherwise terminated by revocation, destruction or other affirmative action.
Third: Hereby ratifying and confirming all that said attorney(s) or substitute(s)
do or cause to be done.
In witness whereof I have hereunto signed my name and affixed my seal this ___________ day of _____________________ 20___________ .
_______________________________________ (Signature of Principal) (Seal)
(ACKNOWLEDGEMENT)
This power of attorney shall not be affected by the subsequent incompetency of the
donor.
In witness whereof I have hereunto signed my name and affixed my seal this ___________ day of _____________________ 20___________ .
_______________________________________ (Signature of Principal) (Seal)
(ACKNOWLEDGEMENT)