Power Of Attorney New York Statutory Short Form (Page 4 of 6) in pdf

New York Statutory Short Form Power of Attorney, Effective. Sept. 12, 2010

(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 the ____ day of ____________, 20__

PRINCIPAL signs here: ====>

______________________________________

STATE OF NEW YORK

)

ss:

COUNTY OF ____________ )

On the ____ day of __________________, 20__, before me, the undersigned, personally appeared

___________________________________________________, personally known to me or proved to me on

the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and

acknowledged to me that he/she executed the same in his/her capacity, and that by his/her signature on the

instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument.

Notary Public

(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;

Chapter 340 of the Laws of 2010, the New York Legislature

Page 4 of 6

Power Of Attorney New York Statutory Short Form Page 4

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