Power Of Attorney - New York Statutory Short Form Page 6
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9New York State Bar Association
New York Statutory Short Form Power of Attorney, 8/18/10, Eff. 9/12/10
(p) SUCCESSOR AGENT’S SIGNATURE AND ACKNOWLEDGMENT OF APPOINTMENT:
It is not required that the principal and the SUCCESSOR agent(s), if any, sign at the same time, nor
that multiple SUCCESSOR agents sign at the same time. Furthermore, successor agents can not use this
power of attorney unless the agent(s) designated above is/are unable or unwilling to serve.
I/we, _________________________, have read the foregoing Power of Attorney. I am/we are the
person(s) identified therein as SUCCESSOR agent(s) for the principal named therein.
Successor 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 6 of 9
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