Colorado Statutory Power of Attorney Form

STATE OF COLORADO STATUTORY FORM

POWER OF ATTORNEY

IMPORTANT INFORMATION

THIS POWER OF ATTORNEY AUTHORIZES ANOTHER PERSON (YOUR AGENT) TO

MAKE DECISIONS CONCERNING YOUR PROPERTY FOR YOU (THE PRINCIPAL).

YOUR AGENT WILL BE ABLE TO MAKE DECISIONS AND ACT WITH RESPECT TO

YOUR PROPERTY (INCLUDING YOUR MONEY) WHETHER OR NOT YOU ARE ABLE

TO ACT FOR YOURSELF. THE MEANING OF AUTHORITY OVER SUBJECTS LISTED

ON THIS FORM IS EXPLAINED IN THE "UNIFORM POWER OF ATTORNEY ACT",

PART 7 OF ARTICLE 14 OF TITLE 15, COLORADO REVISED STATUTES.

THIS POWER OF ATTORNEY DOES NOT AUTHORIZE THE AGENT TO MAKE

HEALTH CARE DECISIONS FOR YOU.

YOU SHOULD SELECT SOMEONE YOU TRUST TO SERVE AS YOUR AGENT.

UNLESS YOU SPECIFY OTHERWISE, GENERALLY THE AGENT'S AUTHORITY WILL

CONTINUE UNTIL YOU DIE OR REVOKE THE POWER OF ATTORNEY OR THE

AGENT RESIGNS OR IS UNABLE TO ACT FOR YOU.

YOUR AGENT IS ENTITLED TO REASONABLE COMPENSATION UNLESS YOU

STATE OTHERWISE IN THE SPECIAL INSTRUCTIONS.

THIS FORM PROVIDES FOR DESIGNATION OF ONE AGENT. IF YOU WISH TO

NAME MORE THAN ONE AGENT YOU MAY NAME A COAGENT IN THE SPECIAL

INSTRUCTIONS. COAGENTS ARE NOT REQUIRED TO ACT TOGETHER UNLESS

YOU INCLUDE THAT REQUIREMENT IN THE SPECIAL INSTRUCTIONS.

IF YOUR AGENT IS UNABLE OR UNWILLING TO ACT FOR YOU, YOUR POWER OF

ATTORNEY WILL END UNLESS YOU HAVE NAMED A SUCCESSOR AGENT. YOU

MAY ALSO NAME A SECOND SUCCESSOR AGENT.

THIS POWER OF ATTORNEY BECOMES EFFECTIVE IMMEDIATELY UNLESS YOU

STATE OTHERWISE IN THE SPECIAL INSTRUCTIONS.

IF YOU HAVE QUESTIONS ABOUT THE POWER OF ATTORNEY OR THE

AUTHORITY YOU ARE GRANTING TO YOUR AGENT, YOU SHOULD SEEK

LEGAL ADVICE BEFORE SIGNING THIS FORM.

DESIGNATION OF AGENT

I _______________________________ (NAME OF PRINCIPAL) NAME THE

FOLLOWING PERSON AS MY AGENT:

NAME OF AGENT:________________________________________________

AGENT ADDRESS:________________________________________________

AGENT TELEPHONE NUMBER:_______________________________________

DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)

IF MY AGENT IS UNABLE OR UNWILLING TO ACT FOR ME, I NAME AS MY

SUCCESSOR AGENT:

NAME OF SUCCESSOR

AGENT:_______________________________________

SUCCESSOR AGENT'S ADDRESS:

_______________________________________

SUCCESSOR AGENT'S TELEPHONE

NUMBER:______________________________

IF MY SUCCESSOR AGENT IS UNABLE OR UNWILLING TO ACT FOR ME, I NAME

AS MY SECOND SUCCESSOR AGENT:

NAME OF SECOND SUCCESSOR

AGENT:________________________________

SECOND SUCCESSOR AGENT'S

ADDRESS:________________________________

SECOND SUCCESSOR AGENT'S TELEPHONE

NUMBER:_______________________

GRANT OF GENERAL AUTHORITY

I GRANT MY AGENT AND ANY SUCCESSOR AGENT GENERAL AUTHORITY TO

ACT FOR ME WITH RESPECT TO THE FOLLOWING SUBJECTS AS DEFINED IN THE

"UNIFORM POWER OF ATTORNEY ACT", PART 7 OF ARTICLE 14 OF TITLE 15,

COLORADO REVISED STATUTES:

(INITIAL EACH SUBJECT YOU WANT TO INCLUDE IN THE AGENT'S GENERAL

AUTHORITY. IF YOU WISH TO GRANT GENERAL AUTHORITY OVER ALL OF THE

SUBJECTS YOU MAY INITIAL "ALL PRECEDING SUBJECTS" INSTEAD OF

INITIALING EACH SUBJECT.)

(___) REAL PROPERTY

(___) TANGIBLE PERSONAL PROPERTY

(___) STOCKS AND BONDS

(___) COMMODITIES AND OPTIONS

(___) BANKS AND OTHER FINANCIAL INSTITUTIONS

(___) OPERATION OF ENTITY OR BUSINESS

(___) INSURANCE AND ANNUITIES

(___) ESTATES, TRUSTS, AND OTHER BENEFICIAL INTERESTS

(___) CLAIMS AND LITIGATION

(___) PERSONAL AND FAMILY MAINTENANCE

(___) BENEFITS FROM GOVERNMENTAL PROGRAMS OR CIVIL OR MILITARY SERVICE

(___) RETIREMENT PLANS

(___) TAXES

(___) ALL PRECEDING SUBJECTS

GRANT OF SPECIFIC AUTHORITY (OPTIONAL)

MY AGENT MAY NOT DO ANY OF THE FOLLOWING SPECIFIC ACTS FOR ME

UNLESS I HAVE INITIALED THE SPECIFIC AUTHORITY LISTED BELOW:

(CAUTION: GRANTING ANY OF THE FOLLOWING WILL GIVE YOUR AGENT

THE AUTHORITY TO TAKE ACTIONS THAT COULD SIGNIFICANTLY REDUCE

YOUR PROPERTY OR CHANGE HOW YOUR PROPERTY IS DISTRIBUTED AT YOUR

DEATH. INITIAL ONLY THE SPECIFIC AUTHORITY YOU WANT TO GIVE YOUR

AGENT.)

(___) CREATE, AMEND, REVOKE, OR TERMINATE AN INTER VIVOS TRUST

(___) MAKE A GIFT, SUBJECT TO THE LIMITATIONS OF THE "UNIFORM POWER OF

ATTORNEY ACT" SET FORTH IN SECTION 15-14-740, COLORADO REVISED

STATUTES, AND ANY SPECIAL INSTRUCTIONS IN THIS POWER OF ATTORNEY

(___) CREATE OR CHANGE RIGHTS OF SURVIVORSHIP

(___) CREATE OR CHANGE A BENEFICIARY DESIGNATION

(___) AUTHORIZE ANOTHER PERSON TO EXERCISE THE AUTHORITY GRANTED

UNDER THIS POWER OF ATTORNEY

(___) WAIVE THE PRINCIPAL'S RIGHT TO BE A BENEFICIARY OF A JOINT AND

SURVIVOR ANNUITY, INCLUDING A SURVIVOR BENEFIT UNDER A RETIREMENT

PLAN

(___) EXERCISE FIDUCIARY POWERS THAT THE PRINCIPAL HAS AUTHORITY TO

DELEGATE

(___) DISCLAIM, REFUSE, OR RELEASE AN INTEREST IN PROPERTY OR A POWER OF

APPOINTMENT

(___) EXERCISE A POWER OF APPOINTMENT OTHER THAN: (1) THE EXERCISE OF A

GENERAL POWER OF APPOINTMENT FOR THE BENEFIT OF THE PRINCIPAL

WHICH MAY, IF THE SUBJECT OF ESTATES, TRUSTS, AND OTHER BENEFICIAL

INTERESTS IS AUTHORIZED ABOVE, BE EXERCISED AS PROVIDED UNDER THE

SUBJECT OF ESTATES, TRUSTS, AND OTHER BENEFICIAL INTERESTS; OR (2)

THE EXERCISE OF A GENERAL POWER OF APPOINTMENT FOR THE BENEFIT OF

PERSONS OTHER THAN THE PRINCIPAL WHICH MAY, IF THE MAKING OF A GIFT

IS SPECIFICALLY AUTHORIZED ABOVE, BE EXERCISED UNDER THE SPECIFIC

AUTHORIZATION TO MAKE GIFTS

(___) EXERCISE POWERS, RIGHTS, OR AUTHORITY AS A PARTNER, MEMBER, OR

MANAGER OF A PARTNERSHIP, LIMITED LIABILITY COMPANY, OR OTHER

ENTITY THAT THE PRINCIPAL MAY EXERCISE ON BEHALF OF THE ENTITY AND

HAS AUTHORITY TO DELEGATE EXCLUDING THE EXERCISE OF SUCH POWERS,

RIGHTS, AND AUTHORITY WITH RESPECT TO AN ENTITY OWNED SOLELY BY

THE PRINCIPAL WHICH MAY, IF OPERATION OF ENTITY OR BUSINESS IS

AUTHORIZED ABOVE, BE EXERCISED AS PROVIDED UNDER THE SUBJECT OF

OPERATION OF THE ENTITY OR BUSINESS

LIMITATION ON AGENT'S AUTHORITY

AN AGENT THAT IS NOT MY ANCESTOR, SPOUSE, OR DESCENDANT MAY NOT

USE MY PROPERTY TO BENEFIT THE AGENT OR A PERSON TO WHOM THE

AGENT OWES AN OBLIGATION OF SUPPORT UNLESS I HAVE INCLUDED THAT

AUTHORITY IN THE SPECIAL INSTRUCTIONS.

SPECIAL INSTRUCTIONS (OPTIONAL)

YOU MAY GIVE SPECIAL INSTRUCTIONS ON THE FOLLOWING LINES:

______________________________________________________________

EFFECTIVE DATE

THIS POWER OF ATTORNEY IS EFFECTIVE IMMEDIATELY UNLESS I HAVE STATED

OTHERWISE IN THE SPECIAL INSTRUCTIONS.

NOMINATION OF CONSERVATOR

OR GUARDIAN(OPTIONAL)

IF IT BECOMES NECESSARY FOR A COURT TO APPOINT A CONSERVATOR OF MY

ESTATE OR GUARDIAN OF MY PERSON, I NOMINATE THE FOLLOWING

PERSON(S) FOR APPOINTMENT:

NAME OF NOMINEE FOR CONSERVATOR OF MY ESTATE:

______________________________________________________________

NOMINEE ADDRESS:_____________________________________________

NOMINEE TELEPHONE NUMBER:_____________________________________

NAME OF NOMINEE FOR GUARDIAN OF MY PERSON:

______________________________________________________________

NOMINEE'S ADDRESS:____________________________________________

NOMINEE'S TELEPHONE

NUMBER:____________________________________

RELIANCE ON THIS POWER OF ATTORNEY

ANY PERSON, INCLUDING MY AGENT, MAY RELY UPON THE VALIDITY OF THIS

POWER OF ATTORNEY OR A COPY OF IT UNLESS THAT PERSON KNOWS IT HAS

TERMINATED OR IS INVALID.

SIGNATURE AND ACKNOWLEDGMENT

____________________________________ ________________________

YOUR SIGNATURE DATE

____________________________________

YOUR NAME PRINTED

____________________________________

YOUR ADDRESS

____________________________________

YOUR TELEPHONE NUMBER

STATE OF ____________________________

[COUNTY] OF _________________________

THIS DOCUMENT WAS ACKNOWLEDGED BEFORE ME ON

____________________,

(DATE)

BY__________________________________.

(NAME OF PRINCIPAL)

____________________________________ (SEAL, IF ANY)

SIGNATURE OF NOTARY

MY COMMISSION EXPIRES: ________________________

THIS DOCUMENT PREPARED BY:

______________________________________________________________

IMPORTANT INFORMATION FOR AGENT

AGENT'S DUTIES

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 UPON YOU LEGAL DUTIES THAT

CONTINUE UNTIL YOU RESIGN OR THE POWER OF ATTORNEY IS TERMINATED

OR REVOKED. YOU MUST:

(1) DO WHAT YOU KNOW THE PRINCIPAL REASONABLY EXPECTS YOU TO DO WITH

THE PRINCIPAL'S PROPERTY OR, IF YOU DO NOT KNOW THE PRINCIPAL'S

EXPECTATIONS, ACT IN THE PRINCIPAL'S BEST INTEREST;

(2) ACT IN GOOD FAITH;

(3) DO NOTHING BEYOND THE AUTHORITY GRANTED IN THIS POWER OF

ATTORNEY; AND

(4) DISCLOSE YOUR IDENTITY AS AN AGENT WHENEVER YOU ACT FOR THE

PRINCIPAL BY WRITING OR PRINTING THE NAME OF THE PRINCIPAL AND

SIGNING YOUR OWN NAME AS "AGENT" IN THE FOLLOWING MANNER:

(PRINCIPAL'S NAME ) BY (YOUR SIGNATURE ) AS AGENT

UNLESS THE SPECIAL INSTRUCTIONS IN THIS POWER OF ATTORNEY STATE

OTHERWISE, YOU MUST ALSO:

(1) ACT LOYALLY FOR THE PRINCIPAL'S BENEFIT;

(2) AVOID CONFLICTS THAT WOULD IMPAIR YOUR ABILITY TO ACT IN THE

PRINCIPAL'S BEST INTEREST;

(3) ACT WITH CARE, COMPETENCE, AND DILIGENCE;

(4) KEEP A RECORD OF ALL RECEIPTS, DISBURSEMENTS, AND TRANSACTIONS

MADE ON BEHALF OF THE PRINCIPAL;

(5) COOPERATE WITH ANY PERSON THAT HAS AUTHORITY TO MAKE HEALTH CARE

DECISIONS FOR THE PRINCIPAL TO DO WHAT YOU KNOW THE PRINCIPAL

REASONABLY EXPECTS OR, IF YOU DO NOT KNOW THE PRINCIPAL'S

EXPECTATIONS, TO ACT IN THE PRINCIPAL'S BEST INTEREST; AND

(6) ATTEMPT TO PRESERVE THE PRINCIPAL'S ESTATE PLAN IF YOU KNOW THE PLAN

AND PRESERVING THE PLAN IS CONSISTENT WITH THE PRINCIPAL'S BEST

INTEREST.

TERMINATION OF AGENT'S AUTHORITY

YOU MUST STOP ACTING ON BEHALF OF THE PRINCIPAL IF YOU LEARN OF ANY

EVENT THAT TERMINATES THIS POWER OF ATTORNEY OR YOUR AUTHORITY

UNDER THIS POWER OF ATTORNEY. EVENTS THAT TERMINATE A POWER OF

ATTORNEY OR YOUR AUTHORITY TO ACT UNDER A POWER OF ATTORNEY

INCLUDE:

(1) DEATH OF THE PRINCIPAL;

(2) THE PRINCIPAL'S REVOCATION OF THE POWER OF ATTORNEY OR YOUR

AUTHORITY;

(3) THE OCCURRENCE OF A TERMINATION EVENT STATED IN THE POWER OF

ATTORNEY;

(4) THE PURPOSE OF THE POWER OF ATTORNEY IS FULLY ACCOMPLISHED; OR

(5) IF YOU ARE MARRIED TO THE PRINCIPAL, A LEGAL ACTION IS FILED WITH A

COURT TO END YOUR MARRIAGE, OR FOR YOUR LEGAL SEPARATION, UNLESS

THE SPECIAL INSTRUCTIONS IN THIS POWER OF ATTORNEY STATE THAT SUCH

AN ACTION WILL NOT TERMINATE YOUR AUTHORITY.

LIABILITY OF AGENT

THE MEANING OF THE AUTHORITY GRANTED TO YOU IS DEFINED IN THE

"UNIFORM POWER OF ATTORNEY ACT", PART 7 OF ARTICLE 14 OF TITLE 15,

COLORADO REVISED STATUTES. IF YOU VIOLATE THE "UNIFORM POWER OF

ATTORNEY ACT", PART 7 OF ARTICLE 14 OF TITLE 15, COLORADO REVISED

STATUTES, OR ACT OUTSIDE THE AUTHORITY GRANTED, YOU MAY BE LIABLE

FOR ANY DAMAGES CAUSED BY YOUR VIOLATION.

IF THERE IS ANYTHING ABOUT THIS DOCUMENT OR YOUR DUTIES THAT YOU

DO NOT UNDERSTAND, YOU SHOULD SEEK LEGAL ADVICE.

AGENT'S CERTIFICATION AS TO THE VALIDITY OF

POWER OF ATTORNEY AND AGENT'S AUTHORITY

STATE OF _____________________________

COUNTY OF ___________________________

I, ____________________________________ (NAME OF AGENT), CERTIFY

UNDER PENALTY OF PERJURY THAT ______________________________

(NAME OF PRINCIPAL) GRANTED ME AUTHORITY AS AN AGENT OR SUCCESSOR

AGENT IN A POWER OF ATTORNEY DATED ________________________.

I FURTHER CERTIFY THAT TO MY KNOWLEDGE:

(1) THE PRINCIPAL IS ALIVE AND HAS NOT REVOKED THE POWER OF

ATTORNEY OR MY AUTHORITY TO ACT UNDER THE POWER OF ATTORNEY AND

THE POWER OF ATTORNEY AND MY AUTHORITY TO ACT UNDER THE POWER OF

ATTORNEY HAVE NOT TERMINATED;

(2) IF THE POWER OF ATTORNEY WAS DRAFTED TO BECOME EFFECTIVE UPON

THE HAPPENING OF AN EVENT OR CONTINGENCY, THE EVENT OR

CONTINGENCY HAS OCCURRED;

(3) IF I WAS NAMED AS A SUCCESSOR AGENT, THE PRIOR AGENT IS NO

LONGER ABLE OR WILLING TO SERVE; AND

(4) ___________________________________________________

______________________________________________________________

(INSERT OTHER RELEVANT STATEMENTS)

SIGNATURE AND ACKNOWLEDGMENT

____________________________________ ________________________

AGENT'S SIGNATURE DATE

____________________________________

AGENT'S NAME PRINTED

____________________________________

AGENT'S ADDRESS

____________________________________

AGENT'S TELEPHONE NUMBER

THIS DOCUMENT WAS ACKNOWLEDGED BEFORE ME ON

____________________,

(DATE)

BY__________________________________.

(NAME OF AGENT)

____________________________________ (SEAL, IF ANY)

SIGNATURE OF NOTARY

MY COMMISSION EXPIRES: ________________________

THIS DOCUMENT PREPARED BY:

______________________________________________________________

Fillable Printable Colorado Statutory Power of Attorney Form

Fillable Printable Colorado Statutory Power of Attorney Form