Tcdrs Durable Power Of Attorney Page 3
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4TCDRS-67
Revised
Acceptance of Appointment
10/2014
Page 3 of 4
I, ________________________________________(print name), have read the foregoing Power of Attorney and am the
person identified therein as Agent (attorney-in-fact) for ________________________________________(name of grantor
of power of attorney) __________________________(SSN of grantor of power of attorney), the Principal named therein.
I hereby acknowledge the following:
• I owe a duty of loyalty and good faith to the Principal, and must use the powers granted to me only for the benefit of
the Principal.
• I must keep the Principal’s funds and other assets separate and apart from my funds and other assets and titled in the
name of the Principal. I must not transfer title to any of the Principal’s funds or other assets into my name alone. My
name must not be added to the title of any funds or other assets of the Principal, unless I am specifically designated as
Agent for the Principal in the title.
• I must protect, conserve and exercise prudence and caution in my dealings with the Principal’s funds and other assets.
• I must keep a full and accurate record of my acts, receipts and disbursements on behalf of the Principal. I understand
my duty to inform and account for my actions in the manner described on the reverse side of this acceptance.
• I acknowledge my authority to act on behalf of the Principal ceases at the death of the Principal.
• I agree that I will notify TCDRS of the death of the Principal immediately.
I hereby accept the foregoing appointment as Agent for the Principal with full knowledge of the responsibilities imposed on
me, and I will faithfully carry out my duties to the best of my ability.
_______________________ _________________________________________
Date
Signature
________________________________ _________________________ _________________________
Relationship
Home Phone #
Mobile Phone #
_____________________________________________________________________________________
Mailing Address
Correspondence should be sent to: Attorney-in-fact’s address
Principal’s address
TCDRS
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P.O. Box 2034
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Austin, TX 78768-2034
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(512) 328-8889 or 800-823-7782
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Fax: (512) 328-8887
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