Power Of Attorney - New York Statutory Short Form Page 5
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9New York State Bar Association
New York Statutory Short Form Power of Attorney, 8/18/10, Eff. 9/12/10
(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 manners:
(Principal's Name) by (Your Signature) as Agent, or (your signature) as Agent for (Principal's
Name).
You may not use the principal's assets to benefit yourself or anyone else or make gifts to yourself or
anyone else unless the principal has specifically granted you that authority in this document, which is either
a Statutory Gifts Rider attached to a Statutory Short Form Power of Attorney or a Non-Statutory 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, successor agent, monitor
if one has been named in this document, 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 acted outside the
authority granted to you in the Power of Attorney, you may be liable under the law for your violation.
(o)
AGENT'S SIGNATURE AND ACKNOWLEDGMENT OF APPOINTMENT:
It is not required that the principal and the agent(s) sign at the same time, nor that multiple agents
sign at the same time.
I/we, _________________________, have read the foregoing Power of Attorney. I am/we are the
person(s) identified therein as agent(s) for the principal named therein.
I/we acknowledge my/our legal responsibilities.
Agent(s) sign(s) here:
==>
____________________________________________
==>
____________________________________________
STATE OF NEW YORK
)
)
ss:
COUNTY OF ___________ )
On the _____ day of ___________, 20__, before me, the undersigned, personally appeared
____________________, personally known to me or proved to me on the basis of satisfactory evidence to
be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she
executed the same in his/her capacity, and that by his/her signature on the instrument, the individual, or the
person upon behalf of which the individual acted, executed the instrument.
Notary Public
2010 N.Y. Laws ch. 340
Page 5 of 9
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