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Power Of Attorney - Statutory Short Form (With Affidavit Of Effectiveness) Form. This is a New York form and can be use in Real Estate Statewide.
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Tags: Power Of Attorney - Statutory Short Form (With Affidavit Of Effectiveness), New York Statewide, Real Estate
Power of Attorney, Statutory Short Form, Revised 3/2009
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT – THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY
"POWER OF ATTORNEY
NEW YORK STATUTORY SHORT FORM
(A) CAUTION TO THE PRINCIPAL: YOUR POWER OF ATTORNEY IS AN IMPORTANT
DOCUMENT. AS THE "PRINCIPAL," YOU GIVE THE PERSON WHOM YOU CHOOSE (YOUR
"AGENT") AUTHORITY TO SPEND YOUR MONEY AND SELL OR DISPOSE OF YOUR PROPERTY
DURING YOUR LIFETIME WITHOUT TELLING YOU. YOU DO NOT LOSE YOUR AUTHORITY TO
ACT EVEN THOUGH YOU HAVE GIVEN YOUR AGENT SIMILAR AUTHORITY.
WHEN YOUR AGENT EXERCISES THIS AUTHORITY, HE OR SHE MUST ACT ACCORDING TO
ANY INSTRUCTIONS YOU HAVE PROVIDED OR, WHERE THERE ARE NO SPECIFIC
INSTRUCTIONS, IN YOUR BEST INTEREST. "IMPORTANT INFORMATION FOR THE AGENT"
AT THE END OF THIS DOCUMENT DESCRIBES YOUR AGENT'S RESPONSIBILITIES.
YOUR AGENT CAN ACT ON YOUR BEHALF ONLY AFTER SIGNING THE POWER OF ATTORNEY
BEFORE A NOTARY PUBLIC. YOU CAN REQUEST INFORMATION FROM YOUR AGENT AT ANY
TIME. IF YOU ARE REVOKING A PRIOR POWER OF ATTORNEY BY EXECUTING THIS POWER
OF ATTORNEY, YOU SHOULD PROVIDE WRITTEN NOTICE OF THE REVOCATION TO YOUR
PRIOR AGENT(S) AND TO THE FINANCIAL INSTITUTIONS WHERE YOUR ACCOUNTS ARE
LOCATED.
YOU CAN REVOKE OR TERMINATE YOUR POWER OF ATTORNEY AT ANY TIME FOR ANY
REASON AS LONG AS YOU ARE OF SOUND MIND. IF YOU ARE NO LONGER OF SOUND MIND,
A COURT CAN REMOVE AN AGENT FOR ACTING IMPROPERLY.
YOUR AGENT CANNOT MAKE HEALTH CARE DECISIONS FOR YOU. YOU MAY EXECUTE A
"HEALTH CARE PROXY" TO DO THIS.
THE LAW GOVERNING POWERS OF ATTORNEY IS CONTAINED IN THE NEW YORK GENERAL
OBLIGATIONS LAW, ARTICLE 5, TITLE 15. THIS LAW IS AVAILABLE AT A LAW LIBRARY, OR
ONLINE THROUGH THE NEW YORK STATE SENATE OR ASSEMBLY WEBSITES,
WWW.SENATE.STATE.NY.US OR WWW.ASSEMBLY.STATE.NY.US.
IF THERE IS ANYTHING ABOUT THIS DOCUMENT THAT YOU DO NOT UNDERSTAND, YOU
SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU.
(b) DESIGNATION OF AGENT(S):
I, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . residing at. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(insert your name and address)
do hereby appoint:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . residing at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(If 1 person is to be appointed agent, insert the name and address of your agent above)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . residing at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . residing at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . residing at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If you designate more than one agent above, they must act together unless you initial the statement below.
(
) My agents may act SEPARATELY.
(c) DESIGNATION OF SUCCESSOR AGENT(S): (OPTIONAL) If every agent designated above is unable or
unwilling to serve, I appoint as my successor agent(s):
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . residing at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . residing at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . residing at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
name(s) and address(es) of successor agent(s) Successor agents designated above must act together unless you initial
the statement below.
( ) My successor agents may act SEPARATELY.
(d) This POWER OF ATTORNEY shall not be affected by my subsequent incapacity unless I have stated otherwise
below, under "Modifications".
(e) This POWER OF ATTORNEY REVOKES any and all prior Powers of Attorney executed by me unless I have
stated otherwise below, under "Modifications."
If your* are NOT revoking your prior Powers of Attorney, and if you are granting the same authority in two or more
Powers of Attorney, you must also indicate under “Modifications” whether the agents given these powers are to act
together or separately.
(f) GRANT OF AUTHORITY: To grant your agent some or all of the authority below, either
(1) Initial the bracket at each authority you grant, or
(2) Write or type the letters for each authority you grant on the blank line at (P), and initial the
bracket at (P). If you initial (P), you do not need to initial the other lines.
I grant authority to my agent(s) with respect to the following subjects as defined in sections 5-1502A through
5-1502N of the New York General Obligations Law:
(
(
(
(
(
(
(
(
(
(
)
)
)
)
)
)
)
)
)
)
(A) real estate transactions;
(B) chattel and goods transactions;
(C) bond, share, and commodity transactions;
(D) banking transactions;
(E) business operating transactions;
(F) insurance transactions;
(G) estate transactions;
(H) claims and litigation;
(I) personal and family maintenance;
(J) benefits from governmental programs or civil
or military service;
(
(
(
(
(
(
) (K) health care billing and payment matters;
records, reports, and statements;
) (L) retirement benefit transactions;
) (M) tax matters;
) (N) all other matters;
) (O) full and unqualified authority to my agent(s)
to delegate any or all of the foregoing powers to
any person or persons whom my agent(s) select;
) (P) EACH of the matters identified by the
following letters . . . . . . . . . . . . . . . . . . . . . . .
You need not initial the other lines if you
initial line (P).
(g) MODIFICATIONS: (OPTIONAL) In this section, you may make additional provisions, including language to
limit or supplement authority granted to your agent. However, you cannot use this Modifications section to grant
your agent authority to make major gifts or changes to interests in your property. If you wish to grant your agent
such authority, you MUST complete the Statutory Major Gifts Rider. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.......................................................................................
.......................................................................................
.......................................................................................
(h) MAJOR GIFTS AND OTHER TRANSFERS: STATUTORY MAJOR GIFTS RIDER (OPTIONAL) In order
to authorize your agent to make major gifts and other transfers of your property, you must initial the statement below
and execute a Statutory Major Gifts Rider at the same time as this instrument. Initialing the statement below by
*As Enacted
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itself does not authorize your agent to make major gifts and other transfers. The preparation of the Statutory Major
Gifts Rider should be supervised by a lawyer.
( )(SMGR) I grant my agent authority to make major gifts and other transfers
of my property, in accordance with the terms and conditions of the Statutory Major
Gifts Rider that supplements this Power of Attorney.
(i) DESIGNATION OF MONITOR(S): (OPTIONAL)
I wish to designate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,
whose address(es) is (are) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , as
monitor(s). Upon the request of the monitor(s), my agent(s) must provide the monitor(s) with a copy of the power
of attorney and a record of all transactions done or made on my behalf. Third parties holding records of such
transactions shall provide the records to the monitor(s) upon request.
(j) COMPENSATION OF AGENT(S): (OPTIONAL) Your agent is entitled to be reimbursed from your assets for
reasonable expenses incurred on your behalf. If you ALSO wish your agent(s) to be compensated from your assets
for services rendered on your behalf, initial the statement below. If you wish to define "reasonable compensation",
you may do so above, under "Modifications".
( ) My agent(s) shall be entitled to reasonable compensation for services rendered.
(k) ACCEPTANCE BY THIRD PARTIES: I agree to indemnify the third party for any claims that may arise
against the third party because of reliance on this Power of Attorney. I understand that any termination of this
Power of Attorney, whether the result of my revocation of the Power of Attorney or otherwise, is not effective as
to a third party until the third party has actual notice or knowledge of the termination.
(l) TERMINATION: This Power of Attorney continues until I revoke it or it is terminated by my death or other
event described in section 5-1511 of the General Obligations Law. Section 5-1511 of the General Obligations Law
describes the manner in which you may revoke your Power of Attorney, and the events which terminate the Power
of Attorney.
(m) SIGNATURE AND ACKNOWLEDGMENT:
IN WITNESS WHEREOF I have hereunto signed my name on . . . . . . . . . . . . . . . . . . . . . . . . . , 2. . . . . .
PRINCIPAL signs here: � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The G ENERAL OBLIGATIONS LAW § 5-1501B REQUIRES THAT THIS INSTRUMENT BE ACKNOWLEDGED BY THE PRINCIPAL.
STATE OF NEW YORK, COUNTY OF
} ss.:
On the . . . . day of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . in the year . . . . . . . . . .
before me, the undersigned, personally appeared
,
personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed
to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by
his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed
the instrument.
Notary Public – Sign Above and Affix Stamp
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(n) IMPORTANT INFORMATION FOR THE AGENT: 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 on you
legal responsibilities that continue until you resign or the Power of Attorney is terminated or revoked. You must:
(1) act according to any instructions from the principal, or, where there are no instructions, in the
principal's best interest;
(2) avoid conflicts that would impair your ability to act in the principal's best interest;
(3) keep the principal's property separate and distinct from any assets you own or control, unless
otherwise permitted by law;
(4) keep a record or all receipts, payments, and transactions conducted for the principal; and
(5) disclose your identity as an agent whenever you act for the principal by writing or printing the
principal's name and signing your own name as "agent" in either of the following manner: (Principal's
Name) by (Your Signature) as Agent, or (your signature) as Agent for (Principal's Name).
You may not use the principal's assets to benefit yourself or give major gifts to yourself or anyone else unless the
principal has specifically granted you that authority in this Power of Attorney or in a Statutory Major Gifts Rider
attached to this Power of Attorney. If you have that authority, you must act according to any instructions of the
principal or, where there are no such instructions, in the principal's best interest. You may resign by giving written
notice to the principal and to any co-agent, successor agent, monitor if one has been named in this document, or the
principal's guardian if one has been appointed. If there is anything about this document or your responsibilities that
you do not understand, you should seek legal advice.
LIABILITY OF AGENT: The meaning of the authority given to you is defined in New York's General Obligations
Law, Article 5, Title 15. If it is found that you have violated the law or acted outside the authority granted to you
in the Power of Attorney, you may be liable under the law for your violation.
(o) AGENT'S SIGNATURE AND ACKNOWLEDGMENT OF APPOINTMENT: It is not required that the
principal and the agent(s) sign at the same time, nor that multiple agents sign at the same time.
I/we, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , have read the foregoing
Power of Attorney. I am/we are the person(s) identified therein as agent(s) for the principal named therein. I/we
acknowledge my/our legal responsibilities.
AGENT(S) sign(s) here: � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.....................................
.....................................
The G ENERAL OBLIGATIONS LAW § 5-1501B REQUIRES THAT THIS INSTRUMENT BE ACKNOWLEDGED BY THE PRINCIPAL
STATE OF NEW YORK, COUNTY OF
} ss.:
On the
day of
in the year
before me, the undersigned, personally appeared
,
personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed
to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by
his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed
the instrument.
Notary Public – Sign Above and Affix Stamp
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AFFIDAVIT OF EFFECTIVENESS © (TO BE COMPLETED BYAGENT(S) UPON DELIVERY OF THIS POWER)
STATE OF NEW YORK, COUNTY OF
} SS.:
______________________________________________________________________, residing at
_____________________________________________________ (each) being duly sworn do(es) depose and say that I am (we are) the Agent(s)
under the above Power of Attorney and that the power of attorney is in full force and effect. That (a) I/we do not have, at the time of the
transaction, actual notice of the termination or revocation of the Power of Attorney, or notice of any facts indicating that the power of attorney has been terminated or revoked; (b) I/we do not have, at the time of the transaction, actual notice that the Power of Attorney has been
modified in any way that would affect the ability of the AGENT to authorize or engage in the transaction, or notice of any facts indicating
that the Power of Attorney has been so modified; and (c) if I/we was/were named as successor Agent(s), the prior Agent(s) is no longer able
or willing to serve. This affidavit if given for the purpose of the Agent executing a
_________________________________________________________________________________________ [describe documents that are executed]
knowing that ______________________________________________________, will reply upon the representations made herein as inducement to
accept such instrument(s) and this Power of Attorney as evidence of my/our authority to act..
______________________________________
Agent
______________________________________
Agent
Sworn to and Subscribed before me
this ________ day of __________, ______
________________________________
(Notary Sign above and Affix Stamp)
Statutory Power of Attorney
(Pursuant to General Obligations Law § 5-1513)
DISTRICT:
SECTION:
BLOCK:
LOT:
COUNTY OR TOWN:
TITLE NO.
To.
RECORDED AT THE REQUEST OF
RETURN BY MAIL TO:
RESERVE THIS SPACE FOR USE OF RECORDING OFFICE
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