Fillable Printable Statutory Power of Attorney Form - New Mexico

Statutory Power of Attorney Form - New Mexico

New Mexico Statutory Power of Attorney

NOTICE: THIS IS AN IMPORTANT DOCUMENT. THE POWERS GRANTED BY

THIS DOCUMENT ARE BROAD AND SWEEPING. THEY ARE EXPLAINED IN THE

UNIFORM STATUTORY FORM POWER OF ATTORNEY ACT, CHAPTER 45, ARTICLE

5, PART 6 NMSA 1978. IF YOU HAVE ANY QUESTIONS ABOUT THESE POWERS, YOU

SHOULD ASK A LAWYER TO EXPLAIN THEM TO YOU. THIS FORM DOES NOT

PROHIBIT THE USE OF ANY OTHER FORM. YOU MAY REVOKE THIS POWER OF

ATTORNEY IF YOU LATER WISH TO DO SO.

I, ___________________________________________________________ (Name)

reside at __________________________________________________, (Address) New Mexico.

I appoint __________________________________________________________

(Name(s) and address(es)) to serve as my attorney(s)-in-fact.

If any attorney-in-fact appointed above is unable to serve, then I appoint

________________________________________ to serve as successor attorney-in-fact in place

of the person who is unable to serve.

This power of attorney shall not be affected by my incapacity but will terminate upon my

death unless I have revoked it prior to my death. I intend by this power of attorney to avoid a

court-supervised guardianship or conservatorship.

Should my attempt be defeated, I ask that my agent be appointed as guardian or

conservator of my person or estate.

STRIKE THROUGH THE SENTENCE ABOVE IF YOU DO NOT WANT TO

NOMINATE YOUR AGENT AS YOUR GUARDIAN OR CONSERVATOR.

CHECK AND INITIAL THE FOLLOWING PARAGRAPH ONLY IF YOU WANT

YOUR ATTORNEY(S)-IN-FACT TO BE ABLE TO ACT ALONE AND INDEPENDENTLY

OF EACH OTHER. IF YOU DO NOT CHECK AND INITIAL THE FOLLOWING

PARAGRAPH AND MORE THAN ONE PERSON IS NAMED TO ACT ON YOUR BEHALF

THEN THEY MUST ACT JOINTLY.

( ) ________ If more than one person is appointed to serve as my attorney-in-fact then they

may act severally, alone and independently of each other.

My attorney(s)-in-fact shall have the power to act in my name, place and stead in any

way which I myself could do with respect to the following matters to the extent permitted by

law:

INITIAL IN THE BOX IN FRONT OF EACH AUTHORIZATION WHICH YOU

DESIRE TO GIVE TO YOUR ATTORNEY(S)-IN-FACT. YOUR ATTORNEY(S)-IN-FACT

SHALL BE AUTHORIZED TO ENGAGE ONLY IN THOSE ACTIVITIES WHICH ARE

INITIALED.

INITIAL

(____) 1. real estate transactions.

(____) 2. stock and bond transactions.

(____) 3. commodity and option transactions.

(____) 4. tangible personal property transactions.

(____) 5. banking and other financial institution transactions.

(____) 6. business operating transactions.

(____) 7. insurance and annuity transactions.

(____) 8. estate, trust and other beneficiary transactions.

(____) 9. claims and litigation.

(____) 10. personal and family maintenance.

(____) 11. benefits from Social Security, Medicare, Medicaid or other government programs or

civil or military service.

(____) 12. retirement plan transactions.

(____) 13. tax matters, including any transactions with the Internal Revenue Service.

(____) 14. decisions regarding lifesaving and life prolonging medical treatment.

(____) 15. decisions relating to medical treatment, surgical treatment, nursing care,

medication, hospitalization, institutionalization in a nursing home or other facility and home

health care.

(____) 16. transfer of property or income as a gift to the principal's spouse for the purpose of

qualifying the principal for governmental medical assistance.

(____) 17. ALL OF THE ABOVE POWERS, INCLUDING FINANCIAL AND HEALTH

CARE DECISIONS. IF YOU INITIAL THE BOX IN FRONT OF LINE 17, YOU NEED NOT

INITIAL ANY OTHER LINES.

SPECIAL INSTRUCTIONS: ON THE FOLLOWING LINES YOU MAY GIVE

SPECIAL INSTRUCTIONS LIMITING OR EXTENDING THE POWERS YOU HAVE

GRANTED TO YOUR AGENT.

________________________________________________________________________

CHECK AND INITIAL THE FOLLOWING PARAGRAPH IF YOU INTEND FOR

THIS POWER OF ATTORNEY TO BECOME EFFECTIVE ONLY IF YOU BECOME

INCAPACITATED. YOUR FAILURE TO DO SO WILL MEAN THAT YOUR

ATTORNEY(S)-IN-FACT ARE EMPOWERED TO ACT ON YOUR BEHALF FROM THE

TIME YOU SIGN THIS DOCUMENT UNTIL YOUR DEATH UNLESS YOU REVOKE THE

POWER BEFORE YOUR DEATH.

( ) _______ This power of attorney shall become effective only if I become incapacitated. My

attorney(s)-in-fact shall be entitled to rely on notarized statements from two qualified health care

professionals, one of whom shall be a physician, as to my incapacity. By incapacity I mean that

among other things, I am unable to effectively manage my personal care, property or financial

affairs.

This power of attorney will not be affected by lapse of time. I agree that any third party who

receives a copy of this power of attorney may act under it.

________________________

(Signature)

__________________________

(Optional, but preferred: Your social security number)

Dated: _____________________, 20________

ACKNOWLEDGEMENT

NOTICE: IF THIS POWER OF ATTORNEY AFFECTS REAL ESTATE, IT MUST

BE RECORDED IN THE OFFICE OF THE COUNTY CLERK IN EACH COUNTY WHERE

THE REAL ESTATE IS LOCATED.

STATE OF NEW MEXICO )

) ss.

COUNTY OF _________________)

The foregoing instrument was acknowledged before me on __________________,

20___, by ___________________________________________

_______________________________________.

Notary Public

My Commission Expires: _______________________

(seal)