Basic Statutory Durable Power Of Attorney Template (Page 2 of 6) in pdf

Basic Statutory Durable Power Of Attorney Template Page 2

____ (K)

Benefits from social security, Medicare, Medicaid, or other governmental

programs or civil or military service;

____ (L)

Retirement plan transactions;

____ (M)

Tax matters;

____ (N)

ALL OF THE POWERS LISTED IN (A) THROUGH (M). YOU DO

NOT HAVE TO INITIAL THE LINE IN FRONT OF ANY OTHER

POWER IF YOU INITIAL LINE (N).

SPECIAL INSTRUCTIONS:

Special instructions applicable to gifts (initial in front of the following sentence to have it apply):

____ I grant my agent (attorney in fact) the power to apply my property to make gifts

outright to or for the benefit of a person, including by the exercise of a presently

exercisable general power of appointment held by me, except that the amount of a

gift to an individual may not exceed the amount of annual exclusions allowed

from the federal gift tax for the calendar year of the gift.

ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS LIMITING OR

EXTENDING THE POWERS GRANTED TO YOUR AGENT.

_____________________________________________________________________________

UNLESS YOU DIRECT OTHERWISE ABOVE, THIS POWER OF ATTORNEY IS

EFFECTIVE IMMEDIATELY AND WILL CONTINUE UNTIL IT IS REVOKED.

CHOOSE ONE OF THE FOLLOWING ALTERNATIVES BY CROSSING OUT THE

ALTERNATIVE NOT CHOSEN:

(A)

This power of attorney is not affected by my subsequent disability or incapacity.

(B)

This power of attorney becomes effective upon my disability or incapacity.

Statutory Durable Power of Attorney

Page 2

Basic Statutory Durable Power Of Attorney Template Page 2