Durable Power Of Attorney - New York (Page 4 of 10) in pdf

5. Remove Existing Attorneys-in-Fact

Complete this section ONLY if you want to remove one or more existing Attorney(s)-in-Fact

from your account(s). If you do not want to make any changes to your existing Attorneys-in-

Fact, skip to Section 6. If you are not appointing a new Attorney-in-Fact with this form, skip

to Section 8. No notary or witness is required.

Remove ALL existing Attorneys-in-Fact.

Check no more

than one.

Remove ONLY the following Attorney(s)-in-Fact:

Name(s)

6. Add an Attorney-in-Fact

Sections 6 and 7 must be completed by the Attorney-in-Fact.

IMPORTANT INFORMATION FOR THE AGENT: When You accept the authority granted

under this Power of Attorney, a special legal relationship is created between You and the

principal. This relationship imposes on You legal responsibilities that continue until You resign

or the Power of Attorney is terminated or revoked. You must:

(1) act according to any instructions from the principal, or, where there are no instructions,

in the principal’s best interest; (2) avoid conflicts that would impair your ability to act in the

principal’s best interest; (3) keep the principal’s property separate and distinct from any assets

You own or control, unless otherwise permitted by law; (4) keep a record or all receipts,

payments, and transactions conducted for the principal; and (5) disclose your identity as an

agent whenever You act for the principal by writing or printing the principal’s name and sign-

ing your own name as “agent” in either of the following manners: (Principal’s Name) by (Your

Signature) as Agent, or (your signature) as Agent for (Principal’s Name). You may not use

the principal’s assets to benefit yourself or anyone else or make gifts to yourself or anyone

else unless the principal has specifically granted You that authority in this document, which

is either a Statutory Gifts Rider attached to a Statutory Short Form Power of Attorney or a

Non-Statutory Power of Attorney. If You have that authority, You must act according to any

instructions of the principal or, where there are no such instructions, in the principal’s best

interest. You may resign by giving written notice to the principal and to any co-agent, suc-

cessor agent, monitor if one has been named in this document, or the principal’s guardian if

one has been appointed. If there is anything about this document or your responsibilities that

You do not understand, You should seek legal advice. Liability of agent: The meaning of the

authority given to You is defined in New York’s General Obligations Law, Article 5, Title 15. If

it is found that You have violated the law or acted outside the authority granted to You in the

Power of Attorney, You may be liable under the law for your violation.

Be sure to provide your

First Name

M.I.

Last Name

Social Security or Taxpayer ID Number

full legal name.

Date of Birth

Evening Phone

Daytime Phone

Extension

mm dd yyyy

Attorney-in-Fact continues on next page.

1.933269.101

027750104

Page 4 of 10

Durable Power Of Attorney - New York Page 4

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