Fillable Printable Power of Attorney Template - Massachusetts

Power of Attorney Template - Massachusetts

POA 04-10

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P. O. Box 8266

Boston, Massachusetts 02266

www.wellsfargo.com/advantagefunds

Power of Attorney (POA)

Complete this form to designate an individual as attorney-in-fact for your

Wells Fargo Advantage Funds® account(s). An attorney-in-fact cannot be

designated on custodial, estate, or guardianship accounts. If you have

questions, call 1-800-222-8222, 24 hours a day, 7 days a week.

A C C O U N T I N F O R M AT I O N ( P L E A S E P R I N T )

Name of account owner or trustee (ﬁrst, middle initial, last) Social Security number

Name of joint account owner or co-trustee (ﬁrst, middle initial, last) Social Security number

Name of trust* (if applicable) Date of trust (if applicable)

*Trust accounts: Enclose a copy of the title page and the section of the trust document that allows for the

appointment of an agent.

Choose one:

Establish the Power of Attorney designation on all of my Wells Fargo Advantage Funds accounts

(nonretirement and retirement).

Establish this Power of Attorney designation only on the specific Fund and account number(s) listed below.

Fund and account number Fund and account number

T Y P E O F P O W E R O F AT T O R N E Y A N D D E S I G N AT I O N O F AT T O R N E Y - I N - FA C T

This Power of Attorney is (choose one):

Durable (Power of Attorney will continue even if you become incapacitated.)

Nondurable (Power of Attorney will terminate at such time as we receive actual notice of your

incapacitation.)

I, , hereby appoint

, hereinafter referred to

as “agent”) to act for me as my agent and attorney-in-fact for the “account(s)” deﬁned as the accounts designated

in section 1 of this form. The account(s) may include retirement accounts such as an IRA, Qualiﬁed Retirement

Plan (QRP), and/or SEP IRA (collectively referred to as “retirement accounts”).

By having my signature notarized in section 3 of this form, I authorize the agent to act for me and on my behalf

in the same manner and with the same force and eﬀect as if I were acting with respect to such transactions as set

forth below and all things necessary or incidental thereto:

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Inquire about, buy, acquire, sell, redeem, exchange, assign or otherwise transfer to dispose of mutual fund

shares, change my dividend and distribution options, direct and receive disbursements regardless of the

tax consequences of such a disbursement, and exercise any and all investment powers available under

my account(s);

Name of account owner or trustee (and joint owner or co-trustee, if applicable)

Name of attorney-in-fact

<<note: Body copy must be 12 pt. on this form. Styles altered accordingly. DO NOT copy these styles to other forms.

Click here to clear form

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T Y P E O F P O W E R O F AT T O R N E Y A N D D E S I G N AT I O N O F AT T O R N E Y - I N - FA C T ( C O N T I N U E D )

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Receive account statements and act with respect to them;

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Endorse and cash or deposit checks payable to me; open other accounts in my name alone or together with

my agent; and make, execute, and deliver any and all written instruments necessary to eﬀectuate the powers

conferred herein;

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Initiate beneﬁciary changes on the account(s);

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Do any other lawful act with respect to my account(s); and

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If a retirement account is listed as one of my accounts, then in addition to the other powers speciﬁed herein,

make contributions on my behalf; select any distribution option or change the payment options I have

selected; request rollovers or transfers to or from my retirement account, up to and including the total amount

of such account; and exercise the investment powers available under the retirement account as speciﬁed

herein, including the purchase or sale of mutual fund shares held in the retirement account on my behalf.

I N F O R M AT I O N F O R A N D A F F I D AV I T O F A C C O U N T O W N E R ( S )

Notice to Person Executing Power of Attorney

A Power of Attorney is an important legal document. By signing the Power of Attorney, you are authorizing another

person to act for you, the principal. Before you sign this Power of Attorney, you should know these important facts:

Your agent (attorney-in-fact) has no duty to act unless you and your agent agree otherwise in writing.

This document gives your agent the powers to manage, dispose of, sell, and convey your personal property, and

to use your property as security if your agent borrows money on your behalf. This document does not give your

agent the power to accept or receive any of your property, in trust or otherwise, as a gift, unless you speciﬁcally

authorize the agent to accept or receive a gift.

Your agent will have the right to receive reasonable payment for services provided under this Power of Attorney

unless you provide otherwise in this Power of Attorney.

The powers you give your agent will continue to exist for your entire lifetime, unless (a) you state that the Power

of Attorney will last for a shorter period of time; (b) you terminate the Power of Attorney (eﬀective when we

receive written notice from you); or (c) for a nondurable Power of Attorney, you become incapacitated (eﬀective

when we receive written notice of your incapacitation). The powers you give your agent in a durable Power of

Attorney will continue to exist notwithstanding your subsequent disability or incapacity. In other words, the

powers you give your agent in a durable Power of Attorney will continue to exist even if you can no longer make

your own decisions respecting the management of your property.

You may amend or change this Power of Attorney only by executing a new Power of Attorney or by executing

an amendment through the same formalities as an original. You have the right to revoke or terminate this Power

of Attorney at any time. However, you retain this right for a durable Power of Attorney only so long as you are

competent. A nondurable Power of Attorney will automatically terminate at such time as we receive written

notice of your incapacitation.

This Power of Attorney must be dated and must be acknowledged before a notary public.

You should read this Power of Attorney carefully. When eﬀective, this Power of Attorney will give your agent the

right to deal with property that you now have or might acquire in the future. The Power of Attorney is important

to you. If you do not understand the Power of Attorney, or any provision of it, you should obtain the assistance of

an attorney or other qualiﬁed person.

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I N F O R M AT I O N F O R A N D A F F I D AV I T O F A C C O U N T O W N E R ( S ) ( C O N T I N U E D )

Account Owner(s) Agreement

I understand that this Power of Attorney designation shall replace any previous Power of Attorney designation I

have made for the Wells Fargo Advantage Funds account(s) indicated in section 1 of this form.

I agree that any third party may act under this Power of Attorney, whether durable or nondurable, without further

inquiry or investigation and regardless of the date of such authorization. I hereby ratify and conﬁrm any and all

transactions heretofore and hereafter made by the agent pursuant to this Power of Attorney for my account(s). I

agree this Power of Attorney is governed by applicable California law.

I, for myself and my heirs, executors, legal representatives, and assigns, hereby agree to indemnify and hold

harmless Wells Fargo Funds Management, LLC, the transfer agent for Wells Fargo Advantage Funds, and any and all

aﬃliated or nonaﬃliated third parties from and against any and all claims that may arise against such third party by

reason of any action or inaction by such third party having relied on this Power of Attorney, and to pay such third

party promptly on demand, for any and all losses arising out of any act by agent under this Power of Attorney. This

indemniﬁcation and hold harmless provision shall survive any termination of this Power of Attorney.

The signature(s) must be notarized.

Signature of account owner or trustee Print name Date

Signature of joint account owner or co-trustee (if applicable) Print name Date

Notary Public

State of

County of

On this

day of , 20 , before me ,

a notary public, personally appeared , personally

known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name is

subscribed to the within instrument and acknowledged to me that he/she executed the same.

Signature of notary public

My commission expires:

I N F O R M AT I O N F O R A N D A F F I D AV I T O F AT TO R N E Y - I N - FA C T

Notice to Person Accepting the Appointment as Attorney-in-Fact

By acting or agreeing to act as the agent (attorney-in-fact) under this Power of Attorney, you assume the ﬁduciary

and other legal responsibilities of an agent. These responsibilities include:

1. The legal duty to act solely in the interest of the principal and to avoid conflicts of interest.

2. The legal duty to keep the principal’s property separate and distinct from any other property owned or

controlled by you.

You may not transfer the principal’s property to yourself without full and adequate consideration or accept a gift

Name of notary public

Name of account owner(s) or trustee(s)

Notary seal/stamp

I N F O R M AT I O N F O R A N D A F F I D AV I T O F AT TO R N E Y - I N - FA C T ( C O N T I N U E D )

of the principal’s property unless this Power of Attorney speciﬁcally authorizes you to transfer property to yourself

or accept a gift of the principal’s property. If you transfer the principal’s property to yourself without speciﬁc

authorization in the Power of Attorney, you may be prosecuted for fraud and/or embezzlement. If the principal

is 65 years of age or older at the time that the property is transferred to you without authority, you may also be

prosecuted for elder abuse under California Penal Code Section 368. In addition to criminal prosecution, you may

also be sued in civil court.

I have read the foregoing notice and I understand the legal and ﬁduciary duties that I assume by acting or

agreeing to act as the agent under the terms of this Power of Attorney.

IMPORTANT NOTICE: In compliance with the USA Patriot Act of 2001, all ﬁnancial institutions are required to

obtain, verify, and record information that identiﬁes each person who opens an account or is granted authority to

act on an account. What this means: As you are being named agent to act on the above-referenced account(s),

we must ask for your name, address, date of birth, and Social Security number. This information will be veriﬁed to

ensure your identity as required by the USA Patriot Act.

Name of agent (ﬁrst, middle initial, last) Social Security number Date of birth (mm/dd/yy)

Residential address or APO/FPO City State ZIP code

Being duly sworn and deposed, I aﬃrm that ,

as principal, who resides at

, did on

this

day of , 20 , appoint me as his/her/their true and lawful agent by the

foregoing instrument hereby made a part hereof. I further certify, under penalty of perjury, that the personal

information I have provided above is true and accurate.

The agent’s signature must be notarized.

Signature of agent Print name Date

Notary Public

State of

County of

On this

day of , 20 , before me ,

a notary public, personally appeared

, personally

known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name is

subscribed to the within instrument and acknowledged to me that he/she executed the same.

Signature of notary public

My commission expires:

Name of account owner(s) or trustee(s)

Residential mailing address

Name of notary public

Name of agent

Notary seal/stamp

Wells Fargo Funds Management, LLC, a wholly owned subsidiary of Wells Fargo & Company, provides investment advisory and administrative services for Wells Fargo Advantage Funds.

Other aﬃliates of Wells Fargo & Company provide subadvisory and other services for the Funds. The Funds are distributed by Wells Fargo Funds Distributor, LLC, Member FINRA/SIPC,

an aﬃliate of Wells Fargo & Company.

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