STATUTORY SHORT FORM POWER OF ATTORNEY MINNESOTA STATUTES, SECTION 523.23 Before completing and signing this form, the principal must read and initial the IMPORTANT NOTICE TO PRINCIPAL that appears after the signature lines in this form. Before acting on behalf of the principal, the attorney(s)-in-fact must sign this form acknowledging having read and understood the IMPORTANT NOTICE TO ATTORNEY(S)-IN-FACT that appears after the notice to the principal. PRINCIPAL (Name and Address of Person Granting the Power) ________________________________________ ________________________________________ ________________________________________ ATTORNEY(S)-IN-FACT (Name and Address) SUCCESSOR ATTORNEY(S)-IN-FACT (Optional) To act if any named attorney-in-fact dies, resigns, or is otherwise unable to serve. (Name and Address) __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ NOTICE: If more than one attorney-in-fact is designated to act at the same time, make a check or "x" on the line in front of one of the following statements: ____ Each attorney-in-fact may independently exercise the powers granted. ____ All attorneys-in-fact must jointly exercise the powers granted. First Successor ____________________ __________________________________ __________________________________ Second Successor __________________ __________________________________ __________________________________ EXPIRATION DATE (Optional) __________________ _____, ____________ Use Specific Month Day Year Only American LegalNet, Inc. www.FormsWorkFlow.com I, (the above-named Principal) hereby appoint the above named Attorney(s)-in-Fact to act as my attorney(s)-in-fact: FIRST: To act for me in any way that I could act with respect to the following matters, as each of them is defined in Minnesota Statutes, section 523.24: (To grant to the attorney-in-fact any of the following powers, make a check or "x" on the line in front of each power being granted. You may, but need not, cross out each power not granted. Failure to make a check or "x" on the line in front of the power will have the effect of deleting the power unless the line in front of the power of (N) is checked or "x-ed".) ____ (A) real property transactions; I choose to limit this power to real property in _______________ County, Minnesota, described as follows: (Use legal description. Do not use street address.) ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ (If more space is needed, continue on the back or on an attachment.) ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ (B) (C) (D) (E) (F) (G) (H) (I) (J) (K) (L) (M) (N) tangible personal property transactions; bond, share, and commodity transactions; banking transactions; business operating transactions; insurance transactions; beneficiary transactions; gift transactions; fiduciary transactions; claims and litigation; family maintenance; benefits from military service; records, reports, and statements; all of the powers listed in (A) through (M) above and all other matters, other than health care decisions under a health care directive that complies with Minnesota Statutes, chapter 145C. SECOND: (You must indicate below whether or not this power of attorney will be effective if you become incapacitated or incompetent. Make a check or "x" on the line in front of the statement that expresses your intent.) ____ This power of attorney shall continue to be effective if I become incapacitated or incompetent. ____ This power of attorney shall not be effective if I become incapacitated or incompetent. American LegalNet, Inc. www.FormsWorkFlow.com THIRD: My attorney(s)-in-fact MAY NOT make gifts to the attorney(s)-in-fact, or anyone the attorney(s)-in-fact are legally obligated to support, UNLESS I have made a check or an "x" on the line in front of the second statement below and I have written in the name(s) of the attorney(s)-in-fact. The second option allows you to limit the gifting power to only the attorney(s)-in-fact you name in the statement. Minnesota Statutes, section 523.24, subdivision 8, clause (2), limits the annual gift(s) made to my attorney(s)-in-fact, or to anyone the attorney(s)-in-fact are legally obligated to support, to an amount, in the aggregate, that does not exceed the federal annual gift tax exclusion amount in the year of the gift. ____ I do not authorize any of my attorney(s)-in-fact to make gifts to themselves or to anyone the attorney(s)-in-fact have a legal obligation to support. ____ I authorize _____________________________________ (write in name(s)), as my attorney(s)-in-fact, to make gifts to themselves or to anyone the attorney(s)-in-fact have a legal obligation to support. FOURTH: (You may indicate below whether or not the attorney-in-fact is required to make an accounting. Make a check or "x" on the line in front of the statement that expresses your intent.) ____ My attorney-in-fact need not render an accounting unless I request it or the accounting is otherwise required by Minnesota Statutes, section 523.21. ____ My attorney-in-fact m u s t render __________________________________________ (Monthly, Quarterly, Annual) accountings to me or ____________________________________________________________ (Name and Address) during my lifetime, and a final accounting to the personal representative of my estate, if any is appointed, after my death. In Witness Whereof I have hereunto signed my name this _____day of ______________, 20______. _____________________________________ (Signature of Principal) (Acknowledgment of Principal) STATE OF MINNESOTA COUNTY OF ) ss. ) ) The foregoing instrument was acknowledged before me this ___day of ___________, 20___, by ____________________________________ (Insert Name of Principal) __________________________________________ (Signature of Notary Public or other Official) American LegalNet, Inc. www.FormsWorkFlow.com Acknowledgement of notice to attorney(s)-in-fact and specimen signature of attorney(s)-in-fact. By signing below, I acknowledge I have read and understand the IMPORTANT NOTICE TO ATTORNEY(S)-IN-FACT required by Minnesota Statutes, section 523.23, and understand and accept the