Tcdrs Durable Power Of Attorney Page 2
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4TCDRS-67
Revised
Durable Power of Attorney
10/2014
Page 2 of 4
NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING. THEY ARE EXPLAINED
IN THE DURABLE POWER OF ATTORNEY ACT, CHAPTER XII, TEXAS PROBATE CODE. IF YOU HAVE ANY
QUESTIONS ABOUT THESE POWERS, OBTAIN COMPETENT LEGAL ADVICE. THIS DOCUMENT DOES NOT
AUTHORIZE ANYONE TO MAKE MEDICAL AND OTHER HEALTH-CARE DECISIONS FOR YOU. YOU MAY
REVOKE THIS POWER OF ATTORNEY IF YOU LATER WISH TO DO SO.
I,
,
(insert your name and address)
appoint
,
,
(insert the name and address of the person appointed)
(relationship)
as my agent (attorney-in-fact) to act for me in any lawful way with respect to any interest I have in the retirement and any
optional death benefit programs administered by the Texas County & District Retirement System (TCDRS), including, but
not limited to, filing applications, making benefit elections, designating beneficiaries, endorsing checks, receiving funds and
exercising any power with respect to retirement transactions as that power is construed under Section 503 of the Durable
Power of Attorney Act.
I further give and grant unto my said attorney-in-fact full power and authority to do and perform every act necessary and
proper to be done in the exercise of any of the foregoing powers as fully as I might or could do if personally present,
hereby ratifying and confirming all that my said attorney-in-fact shall lawfully do or cause to be done by virtue hereof.
I hereby bind myself to indemnify and hold harmless any third party for any and all loss or damage, including liability,
which said third party may at any time sustain or incur in connection with having accepted and acted under this Power of
Attorney.
This Power of Attorney shall not terminate on my disability. This Power of Attorney is effective upon the date of signa-
ture before a Notary Public. Revocation of this Power of Attorney is not effective as to any third party, including, but not
limited to, TCDRS, until the third party receives actual notice of the revocation.
Principal’s Signature
Effective Date of Power of Attorney
Social Security Number
STATE OF TEXAS
COUNTY OF
This Power of Attorney was subscribed, sworn to, and acknowledged before me on
day of
,
by
Month
Year
Principal’s Name
Notary Public in and for the State of Texas
(SEAL)
Printed Name of Notary
Notary Commission Expires
TCDRS
H
P.O. Box 2034
H
Austin, TX 78768-2034
H
(512) 328-8889 or 800-823-7782
H
Fax: (512) 328-8887
H
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