N.y. Statutory Short Form Power Of Attorney Template (Page 5 of 7) in pdf

N.Y. Statutory Short Form Power of Attorney

Effective 09-01-09

(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;

(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 manner:

(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 give major gifts to yourself or

anyone else unless the principal has specifically granted you that authority in this Power of

Attorney or in a Statutory Major Gifts Rider attached to this 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:

_____________________________________________

N.y. Statutory Short Form Power Of Attorney Template Page 5