Statutory Power Of Attorney Page 4
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13GRANT 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 limitation of Section 217 of the Uniform Power of
Attorney Act 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 surviving 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.
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