Special Power Of Attorney (Page 3 of 5) in pdf

Put your name and

Social Security number

–

at the top of every page.

Name of Principal

Social Security Number

Notice to Person Executing Durable Power of Attorney

Section 5

The authority granted by the CalPERS Special Power of Attorney form is limited to matters relating to

Agent is the

attorney-in-fact

CalPERS, LRS, JRS I and JRS II. The person designated as your attorney-in-fact does not have any authority

over your other real or personal property. If you wish that your attorney-in-fact have authority over your real

and/or personal property, it is recommended that you seek legal counsel.

You may notice that the language contained in the following (Warning) statement refers to more extensive

authority than granted by the CalPERS Special Power of Attorney. This (Warning) statement is required by

Probate Code Section 4128 and must be included in all preprinted durable power of attorney forms even

though the CalPERS Special Power of Attorney does not authorize your attorney-in-fact to do many of

the things mentioned in the following (Warning) statement. Also, if you are concerned with the (Warning)

statement or the extent of the authority being granted by the CalPERS Special Power of Attorney form, we

again urge you to consult with an attorney.

(Warning): Notice to Person Executing Durable Power of Attorney

A durable power of attorney is an important legal document. By signing a durable power of attorney, you

are authorizing another person to act for you, the principal. Before you sign this durable power of attorney,

you should know these important facts:

Your agent (attorney-in-fact) has no duty to act unless you and your agent agree otherwise

•

in writing.

This document gives your agent the powers to manage, dispose of, sell, and convey your real and

•

personal property, and to use your property as security if your agent borrows money on your behalf.

This document does not give your agent the power to accept or receive any of your property, in trust

or otherwise, as a gift, unless you speciﬁ cally authorize the agent to accept or receive a gift.

Your agent will have the right to receive reasonable payment for services provided under this

•

durable power of attorney unless you state otherwise in this power of attorney.

The powers you give your agent will continue to exist for your entire lifetime, unless you state that

•

the durable power of attorney will last for a shorter period of time or unless you otherwise terminate

the durable power of attorney. The powers you give your agent in this durable power of attorney will

continue to exist even if you can no longer make your own decisions regarding the management of

your property.

You can amend or change this durable power of attorney only by executing a new durable power of

•

attorney or by executing an amendment through the same formalities as an original. You have the

right to revoke or terminate this power of attorney at any time as long as you are competent.

This durable power of attorney must be dated and must be acknowledged before a notary public

•

or signed by two witnesses. If it is signed by two witnesses, they must witness either (1) the

principal’s signing of the power of attorney or (2) the principal’s acknowledgement of his or her

signature. A durable power of attorney that may affect real property should be acknowledged before

a notary public so that it can easily be recorded.

You should read this durable power of attorney carefully. When effective, this durable power of

•

attorney will give your agent the right to deal with property that you now have or might acquire in

the future. This durable power of attorney is important to you. If you do not understand the durable

power of attorney or any provision of it, you should obtain the assistance of an attorney or other

qualiﬁ ed person.

PERS-OSS-138 (8/09)

Page 3 of 5

Special Power Of Attorney Page 3

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