Fillable Printable Sample Uniform Statutory Form Power of Attorney - California

Sample Uniform Statutory Form Power of Attorney - California

Uniform Statutory Form Power of Attorney

(California Probate Code Section 4401)

NOTICE: The powers granted by this document are broad and sweeping. They are explained in the Uni-

form Statutory Form Power of Attorney Act (California Probate Code sections 4400-4465). If you have any

questions about these powers, obtain competent legal advice. This document does not authorize anyone to

make medical and other health-care decisions for you. You may revoke this power of attorney if you later

wish to do so.

I ___________________________________________________________________

(your name and address)

appoint _____________________________________________________________

(name and address of the person appointed, or of each person appointed if you want to designate more than one)

as my agent (attorney-in-fact) to act for me in any lawful way with respect to the

following initialed subjects:

INITIAL

____ (A) Real property transactions.

____ (B) Tangible personal property transactions.

____ (C) Stock and bond transactions.

____ (D) Commodity and option transactions.

____ (E) Banking and other nancial institution transactions.

____ (F) Business operating transactions.

____ (G) Insurance and annuity transactions.

____ (H) Estate, trust, and other beneciary transactions.

____ (I) Claims and litigation.

____ (J) Personal and family maintenance.

____ (K) Benets from social secuirty, medicare, medicaid, or other governmental

programs, or civil or military service.

____ (L) Retirement plan transactions.

____ (M) Tax matters.

____ (N) ALL OF THE POWERS LISTED ABOVE.

You need not initial any other lines if you initial line (N).

To grant all of the following powers, initial the line in front of (N) and ignore the lines in front of the other

powers.

To grant one or more, but fewer than all, of the following powers, initial the line in front of each of the

powers 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 with-

held.

(Continued on Reverse)

Special Instructions:

On the following lines, you may give special instructions limiting or extending the powers granted to your

agent.

_____________________________________________________________________________

Unless you direct otherwise above, this power of attorney is effective immediately and will continue until it

is revoked.

This power of attorney will continue to be effective even though I become incapacitated.

Strike the preceding sentence if you do not want this power of attorney to continue if you become incapaci-

tated.

Exercise of power of attorney where more than one agent designated

If I have designated more than one agent, the agents are to act

___________________________________________________________________

If you appointed more than one agent and you want each agent to be able to act alone without the other

agent koining, write the word “separately” in the blank space above. If you do not insert any word in the

blank space, or if you insert the word “jointly”, then all of your agents must act or sign together.

I agree that any third party who receives a copy of this document may act under

it. A third party may seek identication. Revocation of the power of attorney is

not effective as to a third party until the third party has actual knowledge of the

revocation. I agree to the indemnity of the third party for any claims that arise

against the third party because of reliance on this power of attorney.

Signed this _______ day of ____________, 20____

__________________________________

(your signature)

By accepting or acting under the appointment, the agent assumes the duciary and other legal

responsibilities of an agent.

[Include certicate of acknowledgement of notary public in compliance with 1189 of the Civil Code or other applicable law.]

State of California

County of __________________

On ___________________________________________ before me, ________________________________

(here insert name and title of the ofcer)

personally appeared ________________________________________, who proved to me on the basis of

satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and ac-

knowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by

his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s)

acted, executed the instrument.

I certify under the PENALTY OF PERJURY under the laws of the State of California that the foregoing

paragraph is true and correct.

WITNESS my hand and ofcial seal.

Signature ________________________________ (SEAL)