Article One Grant Of Powers (Page 3 of 5) in pdf

Power with Respect to Insurance. To purchase, maintain, surrender, collect or cancel (a)

life insurance or annuities of any kind on my life or the life of any one in whom I have an insurable

interest, (b) liability insurance protecting me and my estate against third party claims, (c) hospital

insurance, medical insurance, Medicare supplement insurance, custodial care insurance, and disability

income insurance for me or any of my dependents, and (d) casualty insurance insuring assets of mine

against loss or damage due to fire, theft, or other commonly insured risk; to pay all insurance premiums,

to select any options under such policies, to increase coverage under any such policy, to borrow against

any such policy, to pursue all insurance claims on my behalf, to adjust insurance losses; and the

foregoing powers shall apply to private and public plans, including, without limitation, Medicare,

Medicaid, and Workers' Compensation.

Initials:

_____________

Principal

Witness

Power to Provide for Principal's Support. To do all acts necessary for maintaining my

customary standard of living, to provide living quarters by purchase, lease or other arrangement, or by

payment of the operating costs of my existing living quarters, including interest, amortization payments,

repairs and taxes, to provide normal domestic help for the operation of my household, to provide

clothing, transportation, medicine, food and incidentals, and if necessary to make all necessary

arrangements, contractual or otherwise, for me at any hospital, hospice, nursing home, convalescent

home or similar establishment, or in my own residence should I desire it, and to assure that all of my

essential needs are provided for at such a facility or in my own residence, as the case may be.

Initials:

_____________

Principal

Witness

Income Tax Returns. To prepare and file any federal, state or local income tax return on

my behalf and to deal with any governmental agency with respect to any of my tax returns.

Initials:

_____________

Principal

Witness

10.

Nomination of Guardian/Conservator.

While I hope that by executing this

instrument I will have obviated the need for a guardianship and conservatorship of my person and of my

estate, if it should become necessary for a guardian or conservator to be appointed for my person or for

my estate, I nominate the Agent to so serve.

11.

Alternate Agents. If the Agent designated in the introductory paragraph of Article One

above

cannot

serve

continue

serve

unavailable

serve,

appoint

____________________________________, to serve as my Alternate Agent (“Alternate Agent”). No

Alternate Agent shall be liable for any act or omission of the initial Agent.

12.

Benefit to Agent. My agent shall be entitled to reasonable compensation for any services

provided as my Agent, which compensation shall be up to $____________ per hour. My agent shall be

entitled to reimbursement of all reasonable expenses incurred as a result of carrying out any provision of

Article One Grant Of Powers Page 3

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