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

Power Of Attorney New York Statutory Short Form Page 6

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

(p) SUCCESSOR AGENT’S SIGNATURE AND ACKNOWLEDGMENT OF APPOINTMENT:

It is not required that the principal and the SUCCESSOR agent(s), if any, sign at the same time, nor

that multiple SUCCESSOR agents sign at the same time. Furthermore, successor agents can not use this

power of attorney unless the agent(s) designated above is/are unable or unwilling to serve.

I/we, __________________________________________________________________________,

have read the foregoing Power of Attorney. I am/we are the person(s) identified therein as SUCCESSOR

agent(s) for the principal named therein.

Successor 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 6 of 6

Power Of Attorney New York Statutory Short Form Page 6