General Power Of Attorney Form (Page 2 of 4) in pdf

General Power Of Attorney Form Page 2

______ (11)

Benefits from military service

______ (12)

Tax matters

______ (13)

Employment of agents

______ (14)

Gifts to charities, and to individuals other than the attorney-in-fact

______ (15)

Gifts to the named attorney-in-fact

(If power of substitution and revocation is to be given, add: 'I also give to such person full

power to appoint another to act as my attorney-in-fact and full power to revoke such

appointment.')

(If period of power of attorney is to be limited, add: 'This power

terminates______________, ________.')

(If power of attorney is to be a durable power of attorney and is to continue in effect after

the incapacity or mental incompetence of the principal, add: 'This power of attorney shall

not be affected by my subsequent incapacity or mental incompetence.')

(If power of attorney is to take effect only after the incapacity or mental incompetence of

the principal, add: 'This power of attorney shall become effective after I become

incapacitated or mentally incompetent.')

(If power of attorney is to be effective to terminate or direct the administration of a

custodial trust, add: 'In the event of my subsequent incapacity or mental incompetence, the

attorney-in-fact of this power of attorney shall have the power to terminate or to direct the

administration of any custodial trust of which I am the beneficiary.')

(If power of attorney is to be effective to determine whether a beneficiary under a custodial

trust is incapacitated or ceases to be incapacitated, add: 'The attorney-in-fact of this power

of attorney shall have the power to determine whether I am incapacitated or whether my

incapacity has ceased for the purposes of any custodial trust of which I am the

beneficiary.')

Dated___________, _______.

(Seal)

Signature __________________

General Power Of Attorney Form Page 2