"Power Of Attorney" New York Statutory Gifts Rider Authorization For Certain Gift Transactions (Page 2 of 3) in pdf

N.Y. Statutory Short Form Power of Attorney

Page 2 of 3

Major Gifts Rider, Effective 9-12-10

(____) I grant the following authority to my agent to make gifts or transfers pursuant to my instructions,

or otherwise for purposes which the agent reasonably deems to be in my best interest.

_____________________________________________________________________________________

OTHER TRANSFERS TO HIMSELF OR HERSELF: (OPTIONAL)

If you wish to authorize your agent to make gifts or transfers to himself or herself, you must grant

that authority in this section, indicating to which agent(s) the authorization is granted, and any

limitations and guidelines.

(____) I grant specific authority for the following agent(s) to make the following gifts to himself or herself.

_____________________________________________________________________________________

This authority must be exercised pursuant to my instructions, or otherwise for purposes which the agent

reasonably deems to be in my best interest.

(d) 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 Statutory Gifts Rider.

(e) SIGNATURE OF PRINCIPAL AND ACKNOWLEDGMENT:

In Witness Whereof I have hereunto signed my name on ____________________________, 20_____.

PRINCIPAL signs here:

________________________________

==>

State of ________________) County of ___________________________________________) ss.:

the

_____

day of

_________________

in the year

______

before me, the undersigned,

____________________________________________________________________

____________________________________________________________________________________,

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.

_____________________________

Signature and Office of individual

taking acknowledgment

"Power Of Attorney" New York Statutory Gifts Rider Authorization For Certain Gift Transactions Page 2