Statutory Form Power Of Attorney (Utah) (Page 3 of 4) in pdf

Statutory Form Power Of Attorney (Utah) Page 3

GRANT OF SPECIFIC AUTHORITY (OPTIONAL)

My agent MAY NOT do any of the following specific acts for me UNLESS I have

INITIALED the specific authority listed below:

(CAUTION: Granting any of the following will give your agent the authority to take

actions that could significantly reduce your property or change how your property is distributed

at your death. INITIAL ONLY the specific authority you WANT to give your agent.)

___ Create, amend, revoke, or terminate an inter vivos trust

___ Make a gift, subject to the limitations of Section 75-9-217, and any special

instructions in this power of attorney

___ Create or change rights of survivorship

___ Create or change a beneficiary designation

___ Authorize another person to exercise the authority granted under this power of

attorney

___ Waive the principal's right to be a beneficiary of a joint and survivor annuity,

including a survivor benefit under a retirement plan

___ Exercise fiduciary powers that the principal has authority to delegate

___ Disclaim or refuse an interest in property, including a power of appointment

LIMITATION ON AGENT'S AUTHORITY

An agent that is not my ancestor, spouse, or descendant MAY NOT use my property to

benefit the agent or a person to whom the agent owes an obligation of support unless I have

included that authority in the Special Instructions.

SPECIAL INSTRUCTIONS (OPTIONAL)

You may give special instructions on the following lines:

______________________________________________________________________________

Utah Statutory Power of Attorney Form for ___________________________

Page 3 of 4 Initials:_______

Statutory Form Power Of Attorney (Utah) Page 3