N.y. Statutory Short Form Power Of Attorney Template (Page 2 of 7) in pdf

N.y. Statutory Short Form Power Of Attorney Template Page 2

N.Y. Statutory Short Form Power of Attorney

Effective 09-01-09

(b) DESIGNATION OF AGENT(S):

, hereby appoint:

[name and address of principal]

as my agent(s)

[name(s) and address(es) of agent(s)]

If you designate more than one agent above, they must act together unless you initial the

statement below.

(

) My agents may act SEPARATELY.

If every agent designated above is unable or unwilling to serve, I appoint as my successor agent(s):

[name(s) and address(es) of successor agent(s)]

Successor agents designated above must act together unless you initial the statement below.

(

) My successor agents may act SEPARATELY.

(d) This POWER OF ATTORNEY shall not be affected by my subsequent incapacity unless I

have stated otherwise below, under 'Modifications".

(e) This POWER OF ATTORNEY REVOKES any and all prior Powers of Attorney executed

by me unless I have stated otherwise below, under "Modifications."

If you are NOT revoking your prior Powers of Attorney, and if you are granting the same

authority in two or more Powers of Attorney, you must also indicate under "Modifications"

whether the agents given these powers are to act together or separately.

(f) GRANT OF AUTHORITY:

To grant your agent some or all of the authority below, either

(1) Initial the bracket at each authority you grant, or

(2) Write or type the letters for each authority you grant on the blank line at (P), and

initial the bracket at (P). If you initial (P), you do not need to initial the other lines.

N.y. Statutory Short Form Power Of Attorney Template Page 2