Special Power Of Attorney For Calstrs printable pdf download

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Special Power of Attorney

MS 1307 (Rev.11/00)

WARNING TO PERSON EXECUTING THIS DOCUMENT

This is an important legal document. It creates a durable power of attorney. Before executing this document, you should know

these important facts:

This document may provide the person you designate as your attorney in fact with broad powers with respect to your State Teachers'

Retirement System benefits including powers to manage, dispose, sell, and convey your real and personal property and to borrow

money using your property as security for the loan in connection with those benefits. These powers will exist for an indefinite period

of time unless you limit their duration in this document. These powers will continue to exist notwithstanding your subsequent

disability or incapacity. You have the right to revoke or terminate this power of attorney. If there is anything about this form that

you do not understand, you should ask a lawyer to explain it to you.

__________________________________________,

___________________________________________,

(name of Cal STRS member or benefit recipient)

(street address)

City of ____________________, State of _____, Zip Code ________, Social Security Number

hereby

appoint _______________________________, of ____________________________________________,

(name of attorney in fact)

(street address)

City of

, State of

, Zip Code

, Social Security Number

my true and lawful attorney in fact, for me and in my name, place and stead, and for my use and benefit, to transact all matters relating

to the California State Teachers' Retirement System (CalSTRS) including, but not limited to, filing applications, making benefit elections,

and designating or changing beneficiaries, including designating my attorney in fact.

I further give and grant, unto my said attorney in fact, full power and authority to do and perform every act necessary and proper to be done in

the exercise of any of the foregoing powers as fully as I might or could do if personally present with respect to CalSTRS, hereby ratifying

and confirming all that my said attorney in fact shall lawfully do or cause to be done by virtue hereof.

This power of attorney shall go into effect immediately and shall remain in effect indefinitely notwithstanding my subsequent incapacity,

unless designated to expire on this date __________. My attorney in fact is hereby instructed to notify CalSTRS in writing of my death

immediately upon its occurrence.

Executed before a Notary this _____ day of ________, 20____, at ________________________, _________________

(city)

(state)

___________________________________________

(Signature)

(typed or printed name)

ACKNOWLEDGMENT

State of

__________________)

ss.

County of __________________)

On this ____

day of ____________, 20______ before me, a Notary Public, personally appeared _______________

(name)

_________________________ personally known to me (or proved to me on the basis of satisfactory evidence) to be the

person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the

same in his/her/their authorized capacity(ies) and that by his/her/their signature(s) on the instrument the person(s), or the

entity upon behalf of which the person(s) acted, executed the instrument.

WITNESS my hand and official seal.

(Signature of Notary Public)

California State Teachers’ Retirement System, Office of Program Support Services MS 81

7667 Folsom Boulevard, Post Office Box 15275, Sacramento, CA 95851-0275

(800) 228-5453 or Hearing impaired (916) 229-3541

Special Power Of Attorney For Calstrs

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