Fillable Printable Durable Power of Attorney - South Dakota

Durable Power of Attorney - South Dakota

I. NOTICE - This legal document grants you (Hereinafter referred to as the

“Principal”) the right to transfer unlimited financial powers to someone else

(Hereinafter referred to as the “Attorney-in-Fact”), unlimited financial powers

are described as: all financial decision making power legal under law. The

Principal’s transfer of financial powers to the Attorney-in-Fact are granted

upon authorization of this agreement, and stay in effect in the event of

incapacitation by the Principal (incapacitation is described in Paragraph II).

This agreement does not authorize the Attorney-in-Fact to make medical

decisions for the Principal. The Principal continues to retain every right to all

their financial decision making power and may revoke this Durable Power of

Attorney Form at anytime. The Principal may include restrictions or requests

pertaining to the financial decision making power of the Attorney-in-Fact. It is

the intent of the Attorney-in-Fact to act in the Principal’s wishes put forth, or,

to make financial decisions that fit the Principal’s best interest. All parties

authorizing this agreement must be at least 18 years of age and acting under

no false pressures or outside influences. Upon authorization of this Durable

Power of Attorney Form, it will revoke any previously valid Durable Power of

Attorney Form.

II. INCAPACITATION – The powers granted to the Attorney-in-Fact by the

Principal in this Durable Power of Attorney Form stay in effect upon

incapacitation by the Principal, incapacitation is describes as: A medical

physician stating verbally or in writing that the Principal can no longer make

decisions for them self.

III. REVOCATION - The Principal has the right to revoke this Durable Power of

Attorney Form at anytime. Any revocation will be effective if the Principal

either:

A. Authorizes a new Durable Power of Attorney Form.

B. Authorizes a Power of Attorney Revocation Form.

IV. WITNESS & NOTARY - This document is not valid as a Durable Power of

Attorney unless it is acknowledged before a notary public or is signed by at

least two adult witnesses who are present when the Principal signs or

acknowledges the Principal’s signature. It is recommended to have this

Durable Power of Attorney Form notarized.

SOUTH DAKOTA

DURABLE POWER OF ATTORNEY

V. PRINCIPAL - I, , residing at

Name of

Principal

Street Address of

Principal

City of , State of , appoint

City of Principal State of

Principal

the following as my Attorney-in-Fact, whom I trust with any and all my

financial decision making power immediately upon the authorization of this

form, and in the event that I should become incapacitated:

VI. ATTORNEY-IN-FACT - , residing at

Name of

Attorney-in-Fact

Street Address of

Attorney-in-Fact

City of , State of grant

City of Attorney-in-Fact State of

Attorney-in-Fact

the Attorney-in-Fact the legal authority to act on my behalf for any power legal

under law in regard to my financial decisions under the State of

State

VII. SUCCESSOR ATTORNEY-IN-FACT (Optional) – If the Attorney-in-Fact named

above cannot or is unwilling to serve, then I appoint ,

Name of Successor

Attorney-in-Fact

residing at

Street Address of Successor

Attorney-in-Fact

City of , State of grant

City of Successor Attorney-in-Fact State of Successor

Attorney-in-Fact

the Attorney-in-Fact the legal authority to act on my behalf for any power legal

under law in regard to my financial decisions under the State of

State

VIII. TERMS & CONDITIONS – Upon authorization by all parties, the Attorney-in-

Fact accepts their designation to act in the Principal’s best interests for all

financial decisions legal under law.

TO GRANT ONE OR MORE, BUT FEWER THAN ALL, OF THE FOLLOWING POWERS,

INITIAL THE LINE IN FRONT OF EACH POWER YOU ARE GRANTING.TO WITHHOLD

A POWER, DO NOT INITIAL THE LINE IN FRONT OF IT. YOU MAY, BUT

NEED NOT, CROSS OUT EACH POWER WITHHELD.

Note: If you initial Item A or Item B, which follow, a notarized signature will be

required on behalf of the Principal.

INITIAL

_______ (A) Real property transactions. To lease, sell, mortgage, purchase,

exchange, and acquire, and to agree, bargain, and contract for the lease, sale,

purchase, exchange, and acquisition of, and to accept, take, receive, and

possess any interest in real property whatsoever, on such terms and conditions,

and under such covenants, as my Agent shall deem proper; and to maintain,

repair, tear down, alter, rebuild, improve manage, insure, move, rent, lease,

sell, convey, subject to liens, mortgages, and security deeds, and in any way or

manner deal with all or any part of any interest in real property whatsoever,

including specifically, but without limitation, real property lying and being

situated in the State of California, under such terms and conditions, and under

such covenants, as my Agent shall deem proper and may for all deferred

payments accept purchase money notes payable to me and secured by

mortgages or deeds to secure debt, and may from time to time collect and

cancel any of said notes, mortgages, security interests, or deeds to secure

debt.

_______ (B) Tangible personal property transactions. To lease, sell, mortgage,

purchase, exchange, and acquire, and to agree, bargain, and contract for the

lease, sale, purchase, exchange, and acquisition of, and to accept, take,

receive, and possess any personal property whatsoever, tangible or intangible,

or interest thereto, on such terms and conditions, and under such covenants,

as my Agent shall deem proper; and to maintain, repair, improve, manage,

insure, rent, lease, sell, convey, subject to liens or mortgages, or to take any

other security interests in said property which are recognized under the

Uniform Commercial Code as adopted at that time under the laws of the State

of California or any applicable state, or otherwise hypothecate (pledge), and in

any way or manner deal with all or any part of any real or personal property

whatsoever, tangible or intangible, or any interest therein, that I own at the

time of execution or may thereafter acquire, under such terms and conditions,

and under such covenants, as my Agent shall deem proper.

_______ (C) Stock and bond transactions. To purchase, sell, exchange,

surrender, assign, redeem, vote at any meeting, or otherwise transfer any and

all shares of stock, bonds, or other securities in any business, association,

corporation, partnership, or other legal entity, whether private or public, now

or hereafter belonging to me.

_______ (D) Commodity and option transactions. To organize or continue and

conduct any business which term includes, without limitation, any farming,

manufacturing, service, mining, retailing or other type of business operation in

any form, whether as a proprietorship, joint venture, partnership, corporation,

trust or other legal entity; operate, buy, sell, expand, contract, terminate or

liquidate any business; direct, control, supervise, manage or participate in the

operation of any business and engage, compensate and discharge business

managers, employees, agents, attorneys, accountants and consultants; and, in

general, exercise all powers with respect to business interests and operations

which the principal could if present and under no disability.

_______ (E) Banking and other financial institution transactions. To make,

receive, sign, endorse, execute, acknowledge, deliver and possess checks,

drafts, bills of exchange, letters of credit, notes, stock certificates, withdrawal

receipts and deposit instruments relating to accounts or deposits in, or

certificates of deposit of banks, savings and loans, credit unions, or other

institutions or associations. To pay all sums of money, at any time or times,

that may hereafter be owing by me upon any account, bill of exchange, check,

draft, purchase, contract, note, or trade acceptance made, executed,

endorsed, accepted, and delivered by me or for me in my name, by my Agent.

To borrow from time to time such sums of money as my Agent may deem

proper and execute promissory notes, security deeds or agreements, financing

statements, or other security instruments in such form as the lender may

request and renew said notes and security instruments from time to time in

whole or in part. To have free access at any time or times to any safe deposit

box or vault to which I might have access.

_______ (F) Business operating transactions. To conduct, engage in, and

otherwise transact the affairs of any and all lawful business ventures of

whatever nature or kind that I may now or hereafter be involved in.

_______ (G) Insurance and annuity transactions. To exercise or perform any

act, power, duty, right, or obligation, in regard to any contract of life,

accident, health, disability, liability, or other type of insurance or any

combination of insurance; and to procure new or additional contracts of

insurance for me and to designate the beneficiary of same; provided, however,

that my Agent cannot designate himself or herself as beneficiary of any such

insurance contracts.

_______ (H) Estate, trust, and other beneficiary transactions. To accept,

receipt for, exercise, release, reject, renounce, assign, disclaim, demand, sue

for, claim and recover any legacy, bequest, devise, gift or other property

interest or payment due or payable to or for the principal; assert any interest

in and exercise any power over any trust, estate or property subject to

fiduciary control; establish a revocable trust solely for the benefit of the

principal that terminates at the death of the principal and is then distributable

to the legal representative of the estate of the principal; and, in general,

exercise all powers with respect to estates and trusts which the principal could

exercise if present and under no disability; provided, however, that the Agent

may not make or change a will and may not revoke or amend a trust revocable

or amendable by the principal or require the trustee of any trust for the

benefit of the principal to pay income or principal to the Agent unless specific

authority to that end is given.

_______ (I) Claims and litigation. To commence, prosecute, discontinue, or

defend all actions or other legal proceedings touching my property, real or

personal, or any part thereof, or touching any matter in which I or my

property, real or personal, may be in any way concerned. To defend, settle,

adjust, make allowances, compound, submit to arbitration, and compromise all

accounts, reckonings, claims, and demands whatsoever that now are, or

hereafter shall be, pending between me and any person, firm, corporation, or

other legal entity, in such manner and in all respects as my Agent shall deem

proper.

_______ (J) Personal and family maintenance. To hire accountants, attorneys

at law, consultants, clerks, physicians, nurses, agents, servants, workmen, and

others and to remove them, and to appoint others in their place, and to pay

and allow the persons so employed such salaries, wages, or other

remunerations, as my Agent shall deem proper.

_______ (K) Benefits from Social Security, Medicare, Medicaid, or other

governmental programs, or military service. To prepare, sign and file any claim

or application for Social Security, unemployment or military service benefits;

sue for, settle or abandon any claims to any benefit or assistance under any

federal, state, local or foreign statute or regulation; control, deposit to any

account, collect, receipt for, and take title to and hold all benefits under any

Social Security, unemployment, military service or other state, federal, local or

foreign statute or regulation; and, in general, exercise all powers with respect

to Social Security, unemployment, military service, and governmental benefits,

including but not limited to Medicare and Medicaid, which the principal could

exercise if present and under no disability.

_______ (L) Retirement plan transactions. To contribute to, withdraw from and

deposit funds in any type of retirement plan (which term includes, without

limitation, any tax qualified or nonqualified pension, profit sharing, stock

bonus, employee savings and other retirement plan, individual retirement

account, deferred compensation plan and any other type of employeebenefit

plan); select and change payment options for the principal under any

retirement plan; make rollover contributions from any retirement plan to other

retirement plans or individual retirement accounts; exercise all investment

powers available under any type of self-directed retirement plan; and, in

general, exercise all powers with respect to retirement plans and retirement

plan account balances which the principal could if present and under no

disability.

_______ (M) Tax matters. To prepare, to make elections, to execute and to file

all tax, social security, unemployment insurance, and informational returns

required by the laws of the United States, or of any state or subdivision

thereof, or of any foreign government; to prepare, to execute, and to file all

other papers and instruments which the Agent shall think to be desirable or

necessary for safeguarding of me against excess or illegal taxation or against

penalties imposed for claimed violation of any law or other governmental

regulation; and to pay, to compromise, or to contest or to apply for refunds in

connection with any taxes or assessments for which I am or may be liable.

IX. THIRD PARTIES – I, the Principal, agree that any third party receiving a

copy via: physical copy, email, or fax that I, the Principal, will indemnify and

hold harmless any and all claims that may be put forth in reference to this

Durable Power of Attorney Form.

X. COMPENSATION – The Attorney-in-Fact agrees not to be compensated for

acting in the presence of the Principal. The Attorney-in-Fact may be, but not

entitled to, reimbursement for all: food, travel, and lodging expenses for

acting in the presence of the Principal.

XI. DISCLOSURE - I intend for my attorney-in-fact under this Power of Attorney

to be treated, as I would be with respect to my rights regarding the use and

disclosure of my individually identifiable health information or other medical

records. This release authority applies to any information governed by the

Health Insurance Portability and Accountability Act of 1996 (aka HIPAA), 42 USC

1320d and 45 CFR 160-164

XII. PRINCIPAL’S SIGNATURE - I, , the Principal,

Printed Name of

Principal

sign my name to this power of attorney this day of

Day

and, being first duly sworn, do declare to the

Month

undersigned authority that I sign and execute this instrument as my power of

attorney and that I sign it willingly, or willingly direct another to sign for me,

that I execute it as my free and voluntary act for the purposes expressed in the

power of attorney and that I am eighteen years of age or older, of sound mind

and under no constraint or undue influence.

Signature of

Principal

XIII. ATTORNEY-IN-FACT’S SIGNATURE- I,

Name of

Attorney-in-Fact

have read the attached power of attorney and am the person identified as the

attorney-in-fact for the principal. I hereby acknowledge and accept my

appointment as Attorney-in-Fact and that when I act as agent I shall exercise

the powers for the benefit of the principal; I shall keep the assets of the

principal separate from my assets; I shall exercise reasonable caution and

prudence; and I shall keep a full and accurate record of all actions, receipts

and disbursements on behalf of the principal.

Signature of Attorney-in-Fact

Date

XIV. SUCCESSOR ATTORNEY-IN-FACT’S SIGNATURE (Optional) -

I, have read the attached power of

Name of successor

Attorney-in-Fact

attorney and am the person identified as the successor attorney-in-fact for the

principal. I hereby acknowledge that I accept my appointment as Successor

Attorney-in-Fact and that, in the absence of a specific provision to the contrary

in the power of attorney, when I act as agent I shall exercise the powers for

the benefit of the principal; I shall keep the assets of the principal separate

from my assets; I shall exercise reasonable caution and prudence; and I shall

keep a full and accurate record of all actions, receipts, and disbursements on

behalf of the principal.

Signature of Successor Attorney-in-Fact

Date

Notary Acknowledgement (Must be completed by Notary)

State of County of Subscribed,

Sworn and acknowledged before me by , the

Principal, and subscribed and sworn to before me by ,

witness, this day of .

Notary Signature

Notary Public

In and for the County of

State of

My commission expires:

Seal

Acknowledgement and Acceptance of Appointment as Attorney-in-Fact

I, have read the attached power of attorney

Name of

Attorney-in-Fact

and am the person identified as the attorney-in-fact for the principal. I hereby

acknowledge that accept my appointment as Attorney-in-Fact and that when I

act as agent I shall exercise the powers for the benefit of the principal; I shall

keep the assets of the principal separate from my assets; I shall exercise

reasonable caution and prudence; and I shall keep a full and accurate of all

actions, receipts and disbursements on behalf of the principal.

Signature of Attorney-in-Fact

Date

Acceptance of Appointment as successor Attorney-in-Fact

I, have read the attached power of

Name of successor

Attorney-in-Fact

attorney and am the person identified as the successor attorney-in-fact for the

principal. I hereby acknowledge that I accept my appointment as Successor

Attorney-in-Fact and that, in the absence of a specific provision to the contrary

in the power of attorney, when I act as agent I shall exercise the powers for

the benefit of the principal; I shall keep the assets of the principal separate

from my assets; I shall exercise reasonable caution and prudence; and I shall

keep a full and accurate record of all actions, receipts, and disbursements on

behalf of the principal.

Signature of Successor Attorney-in-Fact

Date

Witness Attestation

I, , the first witness, and I

Printed Name of First Witness Printed Name of Second

Witness

the second witness, sign my name to the foregoing power of attorney being

first duly sworn and do not declare to the undersigned authority that the

principal signs and executed this instrument as him or her, and that I, in the

presence and hearing of the principal, sign this power of attorney as witness to

the principal’s signing and that to the best of my knowledge the principal is

eighteen years of age or older, of sound mind and under no constraint or undue

influence.

Signature of First Witness Signature of Second

Witness