Power Of Attorney New York Statutory Short Form Page 3
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6New York Statutory Short Form Power of Attorney, Effective. Sept. 12, 2010
(
) (G) estate transactions;
(
) (H) claims and litigation;
(
) (I) personal and family maintenance: If you grant your agent this authority, it will allow the agent to
make gifts that you customarily have made to individuals, including the agent, and charitable
organizations. The total amount of all such gifts in any one calendar year cannot exceed five
hundred dollars;
(
) (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 gifts or changes to interests in your property. If you wish to grant your agent such
authority, you MUST complete the Statutory Gifts Rider.
(h)
CERTAIN GIFT TRANSACTIONS: STATUTORY GIFTS RIDER (OPTIONAL)
In order to authorize your agent to make gifts in excess of an annual total of $500 for all gifts
described in (I) of the grant of authority section of this document (under personal and family maintenance),
you must initial the statement below and execute a Statutory Gifts Rider at the same time as this instrument.
Initialing the statement below by itself does not authorize your agent to make gifts. The preparation of the
Statutory Gifts Rider should be supervised by a lawyer.
(
) (SGR) I grant my agent authority to make gifts in accordance with the terms and conditions of the
Statutory Gifts Rider that supplements this Statutory Power of Attorney.
(i)
DESIGNATION OF MONITOR(S): (OPTIONAL)
If you wish to appoint monitor(s), initial and fill in the section below:
(
) 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.
Chapter 340 of the Laws of 2010, the New York Legislature
Page 3 of 6
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