New York Public Employee Retirement System Special Durable Power Of Attorney (Page 5 of 6) in pdf

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Print name

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Address

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City, State, Zip Code

Please note:

The person who takes the acknowledgment may also serve as one of the witnesses.

(l) IMPORTANT INFORMATION FOR THE AGENT:

When you accept the

authority granted under this Power of Attorney, a special legal relationship is created between

you and the principal. This relationship imposes on you legal responsibilities that continue until

you resign or the Power of Attorney is terminated or revoked. You must:

(1) act according to any instructions from the principal, or, where there are

no instructions, in the principal’s best interest;

(2) avoid conflicts that would impair your ability to act in the principal’s

best interest;

(3) keep the principal’s property separate and distinct from any assets you

own or control, unless otherwise permitted by law;

(4) keep a record or all receipts, payments, and transactions conducted for

the principal; and

(5) disclose your identity as an agent whenever you act for the principal by

writing or printing the principal’s name and signing your own name as

“agent” in either of the following [manner] manners:

(Principal’s Name) by (Your Signature) as Agent; or

(Your Signature) as Agent for (Principal’s Name).

Please Note: You may not act to benefit yourself or anyone else unless permitted by law or in

accordance with this Special Power of Attorney. Under this Special Power of Attorney you may

not designate yourself as a beneficiary of any of the principal’s benefits unless you are the

spouse, domestic partner, parent, or child of the principal or you have been specifically granted

such authority in this Power of Attorney. If you have that authority, you must act according to

any instructions of the principal or, where there are no such instructions, in the principal’s best

interest. You may resign by giving written notice to the principal and to any co-agent, or the

principal’s guardian, if one has been appointed.

If there is anything about this document or your responsibilities that you do not

understand, you should seek legal advice.

Liability of agent: The meaning of the authority given to you is defined in New York’s

General Obligations Law, Article 5, Title 15. If it is found that you have violated the law or

New York Public Employee Retirement System Special Durable Power Of Attorney Page 5