Fillable Printable Statutory Form Power of Attorney - Ohio

Statutory Form Power of Attorney - Ohio

_______________________________________________________________________

Ohio Statutory Form Power Of Attorney Cover Letter 1 | Page

STATE OF OHIO

STATUTORY FORM POWER OF ATTORNEY

COVER LETTER

See the “Important Information” section in the attached document. After reviewing the

contents of this packet, you may have additional questions or concerns specific to your

personal situation. In such a case, it is important that you discuss your concerns with

your family and your lawyer. If you are an Ohio resident age 60 or older, you may call

the Pro Seniors’ Senior Legal Helpline at 1-800-488-6070 to schedule a free telephone

appointment for legal advice.

WARNING

Under Ohio law, it is a crime to unlawfully or improperly use an adult’s resources for

monetary or personal benefit, profit, or gain without the adult’s consent. The law may

further require that any person having knowledge of such abuse, neglect or exploitation

of a person age 60 or older report that information to the county office of Adult

Protective Services.

SUBJECTS TO INCLUDE IN YOUR AGENT”S GENERAL AUTHORITY

To give your agent general author ity to act for you with respect to the subjects listed

below, you must also write your INITIALS on the form, on the line to the left of each

subject to include in your agent's general authority. You must initial the subjects you

chose to give to your agent on the form prior to signing the form.

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

Generally in order for your agent to exercise authority over these subjects, you must also

write your INITIALS on the form, on the line to the left of each subject to include in your

agent's general authority. However, if you chose to give your agent authority over all the

subjects listed, instead of initialing each subject, you may simply write your INITIALS

on the form, on the line to the left of "All Preceding Subjects" at the bottom of the subject

list on the form prior to signing the form.

_______________________________________________________________________

Ohio Statutory Form Power Of Attorney Cover Letter 2 | Page

SIGNING AND RECORDING THE FORM

In order for this form to be used in connection with real property transactions, you must

sign and acknowledge the form before a notary public and the form must also be recorded

in the office of the county recorder of the county in which the real property is located

prior to using the form in connection with a real property transaction. (R.C. 1337.04).

Another benefit to signing and acknowledging the form before a notary public is that

your signature on the statutory form power of attorney is presumed to be genuine if you

acknowledge your signature before a notary public and this will greatly facilitate the

form’s acceptance by businesses, banks and other financial institutions. (R.C. 1337.25).

Note that recording the completed statutory form power of attorney in the office of the

county recorder is permitted but not required unless the form will be used in connection

with a real estate transaction. The recording and indexing fees set by the Ohio Revised

Code (R.C. 317.32) are twenty-eight dollars for the first two pages and eight dollars for

each additional page.

StateofOhio‐StatutoryFormPowerofAttorney 1|Page



STATE OF OHIO

STATUTORY FORM POWER OF ATTORNEY

IMPORTANT INFORMATION

1) 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 (sections 1337.21 to 1337.64 of

the Revised Code).

2) This power of attorney does not authorize the agent to make health-care decisions for

you.

3) 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.

4) Your agent is entitled to reasonable compensation unless you state otherwise in the

Special Instructions.

5) 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.

6) 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.

7) This power of attorney becomes effective immediately unless you state otherwise in

the Special Instructions.

ACTIONS REQUIRING EXPRESS AUTHORITY

Unless expressly authorized and initialed by me in the Special Instructions, this power

of attorney does not grant authority to my agent to do any of the following:

(1) Create a trust;

(2) Amend, revoke, or terminate an inter vivos trust, even if specific authority to do so

is granted to the agent in the trust agreement;

(3) Make a gift;

(4) Create or change rights of survivorship;

(5) Create or change a beneficiary designation;

(6) Delegate authority granted under the power of attorney;

(7) Waive the principal's right to be a beneficiary of a joint and survivor annuity,

including a survivor benefit under a retirement plan;

(8) Exercise fiduciary powers that the principal has authority to delegate.

StateofOhio‐StatutoryFormPowerofAttorney 2|Page



CAUTION: Granting any of the above eight powers 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.

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.

STATE OF OHIO

STATUTORY FORM POWER OF ATTORNEY

DESIGNATION OF AGENT

I, _________________________________________________ name the following

person as my agent:

Name of Agent: ____________________________________________________________

Agent’s Address: ___________________________________________________________

Agent’s 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: ( ) ______________________

StateofOhio‐StatutoryFormPowerofAttorney 3|Page



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 (sections 1337.21 to

1337.64 of the Revised Code):

(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

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.

StateofOhio‐StatutoryFormPowerofAttorney 4|Page



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 GUARDIAN (OPTIONAL)

If it becomes necessary for a court to appoint a guardian of my estate or my person, I

nominate the following person(s) for appointment:

Name of Nominee for guardian of my estate: _____________________________________

Nominee’s Address: _________________________________________________________

Nominee’s Telephone Number: ( ) ___________________________________

Name of Nominee for guardian of my person: _____________________________________

Nominee’s Address: _________________________________________________________

Nominee’s Telephone Number: ( ) ___________________________________

StateofOhio‐StatutoryFormPowerofAttorney 5|Page



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 OHIO

COUNTY OF ______________________________

This document was acknowledged before me on __________________________ (Date), by

__________________________________________________________ (Name of Principal).

_________________________________________

Signature of Notary

My commission expires: ______________________________________________________

This document prepared by:

_________________________________________

StateofOhio‐StatutoryFormPowerofAttorney 6|Page



IMPORTANT INFORMATI ON 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;

(4) 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;

(5) 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.

StateofOhio‐StatutoryFormPowerofAttorney 7|Page



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) The 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;

(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 (sections 1337.21 to 1337.64 of the Revised Code). If you violate the Uniform

Power of Attorney Act 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.