Power Of Attorney New York Statutory Short Form (Page 5 of 6) in pdf

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

(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 manners:

(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 anyone else or make gifts to yourself or

anyone else unless the principal has specifically granted you that authority in this document, which is either

a Statutory Gifts Rider attached to a Statutory Short Form Power of Attorney or a Non-Statutory 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:

==>

____________________________________________

==>

____________________________________________

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

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

Page 5 of 6

Power Of Attorney New York Statutory Short Form Page 5

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