Fillable Printable Statutory Power of Attorney Form - Minnesota

Statutory Power of Attorney Form - Minnesota

STATUTORY SHORT FORM POWER OF ATTORNEY

MINNESOTA STATUTES, SECTION 523.23

Before completing and signing this form, the principal must read and initial the IMPORTANT

NOTICE TO THE PRINCIPAL that appears after the signature lines in this form. Before acting on

behalf of the principal, the attorney(s)-in-fact must sign this form acknowledging having read

and understood the IMPORTANT NOTICE TO THE ATTORNEY(S)-IN-FACT that appears after the

notice to the principal

PRINCIPAL (Name and address of person granting the power)

ATTORNEY(S)-IN-FACT SUCCESSOR ATTORNEY(S)-IN-FACT

(Names and Addresses)

(Optional) To act if any named attorney-in-fact dies,

resigns or is otherwise unable to serve.

(Name and Address)

First Successor

Second Successor

NOTICE: If more than one attorney-in-fact is

designated to act at the same time, make a check

or “x” on the line in front of one of the following

statements:

Each attorney-in-fact may independently

EXPIRATION DATE (Optional)

exercise the powers granted.

Use specific month, day and year only

All attorneys-in-fact must jointly exercise

the powers granted.

I (the above named Principal), appoint the above named Attorney(s)-in-fact to act as my attorney(s) in

fact:

FIRST: To act for me in any way I could act with respect to the following matters, as each of them is

defined in Minnesota Statutes, section 523.24:

(To grant the attorney-in fact any of the following powers, make a check or “x” on the line in front of each

power being granted. You may, but need not, cross out each power not granted. Failure to make a check

or “x” on the line in front of the power will have the effect of deleting the power unless the line in front of

the power (N) is checked or x-ed.)

Check or “x”

(A) Real property transactions;

I choose to limit this power to real property in

County, MN

described as follows: (use legal description. Do not use address.)

(If more space is needed, continue on the back or on an attachment.)

(B) Tangible personal property transactions;

(D) Banking transactions;

(E) Business operating transactions;

(F) Insurance transactions;

(G) Beneficiary transactions;

(H) Gift transactions;

(I) Fiduciary transactions;

(J) Claims and litigations;

(K) Family maintenance;

(L) Benefits from military service;

(M) Records, reports, and statements;

(N) All of the powers listed in (A) through (M) above and all other matters other than health care

decisions under a health care directive that complies with Minnesota Statutes, chapter 145C.

SECOND: (you must indicate below whether or not this power of attorney will be effective if you become

incapacitated or incompetent. Make a check or “x” on the line in front of the statement that expresses

you intent.)

This power of attorney shall continue to be effective if I become incapacitated or incompetent.

This power of attorney shall not be effective if I become incapacitated or incompetent.

THIRD: My attorney(s)-in-fact MAY NOT make gifts to the attorney(s)-in-fact, or anyone the attorney-in-

fact is legally obligated to support, UNLESS I have made a check or an “x” on the line in front of the second

statement below and I have written in the name(s) of the attorney(s)-in-fact. The second option allows

you to limit the gifting power to only the attorney(s)-in-fact you name in the statement. Minnesota

Statutes, section 523.24, subdivision 8, clause (2), limits the annual gift(s) made to my attorney(s)-in-fact,

or to anyone the attorney(s)-in-fact are legally obligated to support, to an amount, in the aggregate, that

does not exceed the federal annual gift tax exclusion amount in the year of the gift.

I do not authorize any of my attorney(s)-in-fact to make gifts to themselves or to anyone the

attorney(s) in fact have a legal obligation to support.

authorize (write in names),

as my attorney(s)-in-fact, to make gifts to themselves or to anyone the attorney(s)-in-fact have a

legal obligation to support.

FOURTH: (you may indicate below whether or not the attorney-in-fact is required to make an accounting.

Make a check or “x” on the line in front of the statement that expresses your intent.)

My attorney-in-fact need not render an accounting unless I request it or the accounting is

otherwise required by Minnesota Statutes, section 523.21.

My attorney-in-fact must render (Monthly, Quarterly, Annual)

accountings to me, or

(Name and Address)

during my lifetime, and a final accounting to the personal representative of my estate, if any is

appointed, after my death.

IN WITNESS WHEREOF, I have hereunto signed my name this day of 20

(Signature of Principal)

(Acknowledgment of Principal)

STATE OF MINNESOTA )

) ss.

COUNTY OF )

The foregoing instrument was acknowledged before me this day of

20 , by

(Insert name of principal)

Signature of Notary Public or other official

Acknowledgment of notice to attorney(s)-in-fact and specimen signature of attorney(s)-in-fact.

By signing below, I acknowledge that I have read and understand the IMPORTANT NOTICE TO

ATTORNEY(S)-IN-FACT required by Minnesota Statutes, section 523.23, and understand and accept the

scope of any limitations to the powers and duties delegated to me by this instrument.

(Notarization not required)

Specimen signature(s) of Attorney(s)-in-Fact:

(Notarization not required)

Specimen signature(s) of Attorney(s)-in-Fact:

(Notarization not required)

This instrument was drafted by:

IMPORTANT NOTICE TO THE PRINCIPAL

READ THIS NOTICE CAREFULLY. The power of attorney form that you will be signing is a

legal document. It is governed by Minnesota Statutes, chapter 523. If there is anything about

this form that you do not understand, you should seek legal advice.

PURPOSE: The purpose of the power of attorney is for you, the principal, to give broad

and sweeping powers to your attorney(s)-in-fact, who is the person you designate to handle

your affairs. Any action taken by your attorney(s)-in-fact pursuant to the powers you

designate in this power of attorney form binds you, your heirs and assigns, and the

representative of your estate in the same manner as though you took the action yourself.

POWERS GIVEN: You will be granting the attorney(s)-in-fact power to enter into

transactions relating to any of your real or personal property, even without your consent or

any advance notice to you. The powers granted to the attorney(s)-in-fact are broad and not

supervised. THIS POWER OF ATTORNEY DOES NOT GRANT ANY POWERS TO MAKE HEALTH

CARE DECISIONS FOR YOU. TO GIVE SOMEONE THOSE POWERS, YOU MUST USE A HEALTH

CARE DIRECTIVE THAT COMPLIES WITH MINNESOTA STATUTES, CHAPTER 145(C).

DUTIES OF YOUR ATTORNEY(S)-IN-FACT: Your attorney(s)-in-fact must keep complete

records of all transactions entered into on your behalf. You may request that your attorney(s)-

in-fact provide you or someone else that you designate a periodic accounting, which is a

written statement that gives reasonable notice of all transactions entered into on your behalf.

Your attorney(s)-in-fact must also render an accounting if the attorney-in-fact reimburses

himself or herself for any expenditure they made on behalf of you.

An attorney-in-fact is personally liable to any person, including you, who is injured by

an action taken by an attorney-in-fact in bad faith under the power of attorney or by an

attorney-in-fact’s failure to account when the attorney-in-fact has a duty to account under this

section. The attorney(s)-in-fact must act with your interests utmost in mind.

TERMINATION: If you choose, your attorney(s)-in-fact may exercise these powers

throughout your lifetime, both before and after you become incapacitated. However, a court

can take away the powers of your attorney(s)-in-fact because of improper acts. You may also

revoke this power of attorney if you wish. This power of attorney is automatically terminated

if the power is granted to your spouse and proceedings are commenced for dissolution, legal

separation, or annulment of your marriage.

This power of attorney authorizes, but does not require, the attorney(s)-in-fact to act

for you. You are not required to sign this power of attorney, but it will not take effect without

your signature. You should not sign this power of attorney if you do not understand

everything in it, and what your attorney(s)-in-fact will be able to do if you do sign it.

Please place your initials on the following line indicating you have read this IMPORTANT

NOTICE TO THE PRINCIPAL:

______________

IMPORTANT NOTICE TO THE ATTORNEY(S)-IN-FACT

You have been nominated by the principal to act as an attorney-in-fact. You are under no

duty to exercise the authority granted by the power of attorney. However, when you do

exercise any power conferred by the power of attorney, you must:

act with the interests of the principal utmost in mind;

exercise the power in the same manner as an ordinarily prudent person of discretion

and intelligence would exercise in the management of the person’s own affairs;

3) render accountings as directed by the principal or whenever you reimburse yourself for

expenditures made on behalf of the principal;

4) act in good faith for the best interest of the principal, using due care, competence, and

diligence;

cease acting on behalf of the principal if you learn of any event that terminates this

power of attorney or terminates your authority under this power of attorney, such as

revocation by the principal of the power of attorney, the death of the principal, or the

commencement of proceedings for dissolution, separation, or annulment of your

marriage to the principal;

6) disclose your identity as an attorney-in-fact whenever you act for the principal by

signing in substantially the following manner: Signature by a person as “attorney-in-

fact for (name of principal)” or “(name of principal) by (name of the attorney-in-fact)

the principal’s attorney-in-fact”;

acknowledge you have read and understood this IMPORTANT NOTICE TO THE

ATTORNEY(S)-IN-FACT by signing the power of attorney form.

You are personally liable to any person, including the principal, who is injured by an action

taken by you in bad faith under the power of attorney or by your failure to account when the

duty to account has arisen.

The meaning of the powers granted to you is contained in Minnesota Statutes, chapter

523. If there is anything about this document or your duties that you do not understand, you

should seek legal advice.

REVOCATION OF POWER OF ATTORNEY

Minnesota Statutes, § 523.11

TO WHOM IT MAY CONCERN:

I revoke and declare null and void the

POWER OF ATTORNEY I granted to

which is dated 20

Please be advised that the above-named person no longer has power to act as my attorney-in-fact

in any way.

Date:

(Principal)

STATE OF MINNESOTA

County of

The foregoing instrument was acknowledged before me this day of 20

Notary Public