§ 3-9-301 — Statutory form power of attorney

(a) 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 act:
STATE OF WYOMING
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, W.S. 3-9-101 through 3-9-403. 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 (1) agent. If you wish to name
more than one (1) 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, W.S. 3-9-101 through 3-9-403:
(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, W.S. 3-9-217, 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
(...) Disclaim or refuse an interest in property, including a
power of appointment
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 and 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:
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 shall:
(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 shall 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 shall 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 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, W.S. 3-9-101 through 3-9-403. If
you violate the Uniform Power of Attorney Act, W.S. 3-9-101
through 3-9-403, 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.