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

"Power Of Attorney" New York Statutory Gifts Rider Authorization For Certain Gift Transactions Page 3

N.Y. Statutory Short Form Power of Attorney

Page 3 of 3

Major Gifts Rider, Effective 9-12-10

(f) SIGNATURES OF WITNESSES:

By signing as a witness, I acknowledge that the principal signed the Statutory Gifts Rider in my presence and

the presence of the other witness, or that the principal acknowledged to me that the principal's signature

was affixed by him or her or at his or her direction. I also acknowledge that the principal has stated that

this Statutory Gifts Rider reflects his or her wishes and that he or she has signed it voluntarily. I am not

named herein as a permissible recipient of major gifts.

___________________________

_________________________

Signature of witness 1

Signature of witness 2

___________________________

_________________________

Date

___________________________

_________________________

Print name

___________________________

_________________________

Address

___________________________

__________________________

City, State, Zip code

(g) This document prepared by:

_____________________________________________________

Distributed by:

"Power Of Attorney" New York Statutory Gifts Rider Authorization For Certain Gift Transactions Page 3