New York Statutory Short Form Poa Page 5
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7(l) TERMINATION:
This Power of Attorney continues until I revoke it or it is terminated by my death or other event
described in section 5-1511 of the General Obligations Law. Section 5-1511 of the General Obligations
Law describes the manner in which you may revoke your Power of Attorney, and the events which
terminate the Power of Attorney.
(m) SIGNATURE AND ACKNOWLEDGMENT:
In Witness Whereof I have hereunto signed my name this __________ day of __________, 20___.
(PRINCIPAL SIGNS HERE:) ►__________________________________________
(Signature of Principal)
STATE OF NEW YORK
:
: ss.:
COUNTY OF __________
:
On the __________ day of __________ in the year __________ before me, the undersigned, personally
appeared __________________________________________, personally known to me or proved to me
on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the
within instrument and acknowledged to me that he/she/they executed the same in his/her/their
capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person
upon behalf of which the individual(s) acted, executed the instrument.
_____________________________
Notary Public
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