Power Of Attorney For Digital Assets Template (Page 2 of 2) in pdf

5. SPECIAL INSTRUCTIONS (OPTIONAL)

________________________________________________________________________________________

6. EFFECTIVE DATE

This power of attorney is effective immediately unless I have stated otherwise in the special instructions.

7. RELIANCE ON THIS POWER OF ATTORNEY

Any person, including my agent, may rely upon the validity of this power of attorney, or a paper or electronic

copy of it, unless that person knows it has terminated or is invalid. Principal, as account holder, expressly

authorizes any service provider providing service related to an account owned or used by the principal, to

disclose any private information needed to an authorized fiduciary or agent, acting on behalf of principal.

8. COMPLIANCE WITH STATE AND FEDERAL LAWS AND LICENSING AGREEMENTS

Principal shall provide agent with a copy of any relevant state and federal laws and the Uniform Fiduciary Access

to Digital Assets Act (UFADAA). Agent agrees to read and comply with relevant state and federal laws, and any

license agreements, terms of use, or terms of service, which are subject to change.

9. SIGNATURE AND ACKNOWLEDGMENT

______________________________ ____________________

Signature

Date

______________________________ ______________________________

Printed name

Telephone number

Address ____________________________________________________________

WITNESS AFFIDAVIT (OPTIONAL)

I/we declare that, being first duly sworn, that the principal signed and executed this instrument, knowingly and

willingly, as the principal’s Power of Attorney, and I/we signed this instrument as witness, in the conscious

presence of the principal, and at the time of the execution of this instrument, the principal, according to my/our

best knowledge and belief, was aware and of sound mind, and under no constraint or undue influence.

______________________________ ____________________

Witness #1 signature

Date

______________________________ ______________________________

Witness #1 name printed

Witness #1 telephone number

______________________________ ____________________

Witness #2 signature

Date

______________________________ ______________________________

Witness #2 name printed

Witness #2 telephone number

==================================================================================

State of Colorado, County of ____________________

Acknowledged before me by ______________________________ (principal), and subscribed and sworn to, or

affirmed, before me by ______________________________ (witness) and ____________________________

(witness) on ____________________ (date).

Signature of notary ______________________________ (Seal)

My commission expires: ____________________

Power Of Attorney For Digital Assets Template Page 2

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