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Power Of Attorney Statutory Short Form. This is a Connecticut form and can be use in General Statewide.
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Tags: Power Of Attorney Statutory Short Form, Connecticut Statewide, General
POWER OF ATTORNEY, STATUTORY SHORT FORM
NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING. THEY
ARE DEFINED IN CONNECTICUT STATUTORY SHORT POWER OF ATTORNEY ACT, SECTIONS 1-42 TO
1-56, INCLUSIVE, OF THE GENERAL STATUTES, WHICH EXPRESSLY PERMITS THE USE OF ANY
OTHER OR DIFFERENT FORM OF POWER OF ATTORNEY DESIRED BY THE PARTIES CONCERNED. The
grantor of any power of attorney or the attorney-in-fact may make application to a court of probate for an
accounting as provided in subsection (b) of section 45a-175.
KNOW ALL MEN BY THESE PRESENTS, which are intended to constitute a GENERAL POWER OF
ATTORNEY pursuant to Connecticut Statutory 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:*
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 Connecticut 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 in the opposite box 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 (K), inclusive, shall automatically
constitute an elimination also of subdivision (L).]
TO STRIKE OUT ANY SUBDIVISION THE PRINCIPAL MUST DRAW A LINE THROUGH THE TEXT
OF THAT SUBDIVISION AND WRITE HIS/HER INITIALS IN THE BOX OPPOSITE.
A. real estate transactions;
[
]
G. estate transactions;
[
]
B. chattel and goods transactions;
[
]
H. claims and litigation;
[
]
C. bond, share and commodity transactions
[
]
I.
personal relationships and affairs;
[
]
D. banking transactions;
[
]
J. benefits from military service;
[
]
E. business operating transactions;
[
]
K. records, reports and statements;
[
]
F. insurance transactions;
[
]
L. all other matters;
[
]
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[Special provisions and limitations may be included in the statutory short form power of attorney only if they
conform to the requirements of the Connecticut Statutory Short Form Power of Attorney Act.]
Second: With full and unqualified authority to delegate any or all of the foregoing powers to any person
or persons whom my attorney(s)-in-fact shall select.
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
20
day of
.
Signature of Principal
(Seal)
Signed and sealed in the presence of:**
Witness (print name):
Address of Witness:
Witness (print name):
Address of Witness:
Acknowledgment
State of Connecticut
County of ______________
ss. (Town/City)
On this the_____day of____________, 20____, before me, [Name of Notary] , the undersigned officer,
personally appeared [Name of individual or individuals], known to me (or satisfactorily proven) to be the
person(s) whose name(s) (is or are) subscribed to the within instrument and acknowledged that
(he/she/ they) executed the same for the purposes therein contained.
In witness whereof I hereunto set my hand.
_______________________________________
Signature of Notary Public
Date Commission Expires:_____________
* 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.
** One witness may be notary, attorney, etc. taking the acknowledgment.
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