Power Of Attorney New York Statutory Short Form/power Of Attorney New York Statutory Major Gifts Rider Authorization To Make Major Gifts Or Other Transfers Form (Page 8 of 9) in pdf

Power Of Attorney New York Statutory Short Form/power Of Attorney New York Statutory Major Gifts Rider Authorization To Make Major Gifts Or Other Transfers Form Page 8

OTHER TRANSFERS TO HIMSELF OR HERSELF: (OPTIONAL)

F YOU WISH TO AUTHORIZE YOUR AGENT TO MAKE GIFTS OR TRANSFERS TO HIMSELF OR HERSELF

(

)

YOU MUST GRANT THAT AUTHORITY IN THIS SECTION

INDICATING TO WHICH AGENT

THE

AUTHORIZATION IS GRANTED

AND ANY LIMITATIONS AND GUIDELINES

(____) I grant specific authority for the following agent(s) to make the following major gifts or

other transfers to himself or herself:

_____________________________________________________________________________________

This authority must be exercised pursuant to my instructions, or otherwise for purposes which

the agent reasonably deems to be in my best interest.

(d) ACCEPTANCE BY THIRD PARTIES: I agree to indemnify the third party for any claims that

may arise against the third party because of reliance on this Major Gifts Rider.

(e) SIGNATURE OF PRINCIPAL AND ACKNOWLEDGMENT:

In Witness Whereof I have hereunto signed my name on _______________, 20_____.

PRINCIPAL signs here:

STATE OF NEW YORK

)

) ss.:

COUNTY OF ____________)

On the __________ day of __________________, in the year _______, before me, the

undersigned, a Notary Public in and for said state, personally appeared ___________________

______________________________, personally known to me or proved to me on the basis of

satisfactory evidence to be the person 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 person or the entity upon behalf of which the person acted,

executed the instrument.

[Notary Public]

(f) SIGNATURES OF WITNESSES:

Power Of Attorney New York Statutory Short Form/power Of Attorney New York Statutory Major Gifts Rider Authorization To Make Major Gifts Or Other Transfers Form Page 8

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