Power Of Attorney Form - New York

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New York Power of Attorney
Effective Date: ____/____/______
I, do hereby
[Legal Name], AKA [Name]
A resident of
[City][State]
Located at
[Address]
[City], [State] [Zip Code]
Hereby appoint:
Name
[Legal Name]
A resident of
[City][State]
Located at
[Address]
[City], [State] [Zip Code]
If you designate more than one agent above, by default they must act together unless you
initial the statement below.
[___] My agents may act separately.
(Optional) Designation of Successor Agent(s):
If every agent that is listed above is unable or unwilling to serve, I hereby appoint as my
successor agent(s):
_____________________________________________________________________________
If you designate more than one successor agent above, by default they must act together
unless you initial the statement below.
[___] My successor agents may act separately.
My attorney-in-fact may act on my behalf for the following purpose(s):
________________________________________________________________
________________________________________________________________
________________________________________________________________
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