Limited Power Of Attorney Authorization Form - Tennessee Treasury Department Page 3
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34. Revoca on
This Limited Power of A orney Authoriza on is eff ec ve immediately and will con nue in eff ect un l it is revoked or
terminated by any of the following ac ons:
•
The designated benefi ciary executes a new Limited Power of A orney Authoriza on form for the account selected
in Sec on 1 of this form and submits the new authoriza on to ABLE TN;
•
The designated benefi ciary revokes the Limited Power of A orney Authoriza on in wri ng and submits the
revoca on to ABLE TN;
•
The designated benefi ciary dies;
•
The ABLE account, for which this Limited Power of A orney Authoriza on is applicable, is closed; or
•
A court determina on
I agree that any third party who receives this document may act under it. Revoca on or termina on of this Limited
Power of A orney due to my death, court determina on, or any other reason pursuant to applicable laws and rules,
is not eff ec ve as to a third party un l the third party receives wri en no ce of the revoca on or termina on and the
third party has had a reasonable amount of me to act on such no ce. I, for myself and for my heirs, executors, legal
representa ves and assigns, agree to indemnify and hold harmless the State of Tennessee; the Tennessee Treasury
Department; the Tennessee State Treasurer; the ABLE TN; the ABLE TN Trustees, and any of their respec ve affi liates,
agents, and employees, and any third party ac ng hereunder in connec on with ABLE TN, for any claims that arise
against the third party because of reliance on this Limited Power of A orney Authoriza on.
IF YOU HAVE ANY QUESTIONS ABOUT THIS FORM, CONSULT AN ATTORNEY OR OTHER LEGAL, FINANCIAL OR TAX
ADVISER BEFORE SIGNING.
5. Signature
Signature: _____________________________________________________________________________________
Printed Name: _________________________________________________________________________________
Date: ________________________________________________________________________________________
RDA-11176
TR-0469
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