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Durable Power of Attorney – New York

This form should be used only by residents of New York who wish to grant or modify the

power of a third party (your agent or “Attorney-in-Fact”) to act on your behalf on one or

more Fidelity accounts. Do NOT use this form for any trust, custodial, business, defined

benefit, non-prototype retirement plans, fiduciary accounts, Fidelity Retirement Plans, or

workplace retirement plans, such as a 401(k).

Type on screen or print out and fill in using CAPITAL letters and black ink. If you need more

room for information or signatures, use a copy of the relevant page.

CAUTION TO THE PRINCIPAL: Your Power of Attorney is an important document. As the

“principal,” You give the person whom You choose (your “agent”) authority to spend your

money and sell or dispose of your property during your lifetime without telling You. You do

not lose your authority to act even though You have given your agent similar authority.

When your agent exercises this authority, he or she must act according to any instructions

You have provided or, where there are no specific instructions, in your best interest.

“Important Information for the Agent” in Section 6 of this document describes your agent’s

responsibilities. Your agent can act on your behalf only after signing the Power of Attorney

before a notary public. You can request information from your agent at any time. If You are

revoking a prior Power of Attorney (section 5) You should provide written notice of the revo-

cation to your prior agent(s) and to any third parties who may have acted upon it, including

the financial institutions where your accounts are located.

You can revoke or terminate your Power of Attorney at any time for any reason as long as

You are of sound mind. If You are no longer of sound mind, a court can remove an agent for

acting improperly. Your agent cannot make health care decisions for you. You may execute a

“Health Care Proxy” to do this.

The law governing Powers of Attorney is contained in the New York General Obligations Law,

Article 5, Title 15. This law is available at a law library, or online through the New York State

Senate or Assembly websites, or

If there is anything about this document that You do not understand, You should ask a lawyer

of your own choosing to explain it to You.

Helpful to Know

• This is a very important legal document.

• This is a durable power of attorney (POA),

It gives another person control over your

meaning it remains in effect regardless of

accounts listed in Section 2 and direct access

your physical or mental health — even if

to your money. The person will have the

you become incompetent and can no lon-

power to buy, sell, transfer, and dispose of

ger make your own decisions or manage

any assets in the accounts you identify here,

your own affairs. From the moment you

sign this form, your Attorney-in-Fact will

including assets you may acquire in the

future. Review it carefully with a trusted

have the powers granted by this form until

legal professional before you sign it.

we receive written notice revoking those

powers.

• Your Attorney-in-Fact (the person to whom

you grant power of attorney) may have the

• For 529 plans, references to Principal shall

right to take reasonable payment from your

mean Participant.

account for his/her services.

Helpful to Know continues on next page.

1.933269.101

027750101

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Durable Power Of Attorney - New York

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