Fillable Printable Statutory Power of Attorney Form - New York

Statutory Power of Attorney Form - New York

Effective 09-12-10

Attorney, you should provide written notice of the revocation to your prior agent(s) and to any

third parties who may have acted upon it, including the financial institutions where your accounts

are located.

Effective 09-12-10

You may provide for specific succession rules in this section. Insert specific succession

provisions here:

(e) This POWER OF ATTORNEY

does not revoke any Powers of Attorney previously executed

If you do not intend to revoke your prior Powers of Attorney, and if you have granted the same

authority in this Power of Attorney as you granted to another agent in a prior Power of Attorney,

each agent can act separately unless indicated under "Modifications" that the agents with the same

authority are to act together.

Effective 09-12-10

) (I) personal and family maintenance. If you grant your agent this authority, it will allow the

agent to make gifts that you have customarily have made to individuals, including the agent, and

charitable organizations. The total amount of all such gifts in any one calendar year cannot exceed

five hundred dollars;

use this Modifications section to grant your agent authority to make gifts or changes to interests

in your property. If you wish to grant your agent such authority, you MUST complete

the Statutory Gifts Rider.

(h) CERTAIN GIFT TRANSACTIONS: STATUTORY GIFTS RIDER:

In order to authorize your agent to make gifts in excess of an annual total of $500

for all gifts described in (I) of the grant of authority section of this document (under personal and

family maintenance), you must initial the statement below and execute a Statutory Gifts Rider at

the same time as this instrument. Initialing the statement below by itself does not authorize your

agent to make gifts. The preparation of the Statutory Gifts Rider should be supervised by a lawyer.

) (SGR) I grant my agent authority to make gifts in accordance with the terms and

conditions of the Statutory Gifts Rider that supplements this statutory Power of Attorney.

Effective 09-12-10

If you wish to appoint monitor(s), initial and fill in the section below:

( ) I wish to designate

, whose address(es)

Effective 09-12-10

You may not use the principal’s assets to benefit yourself or any anyone else or make gifts to yourself

or anyone else unless the principal has specifically granted you that authority in this document,

which

either a Statutory Gifts Rider attached to a Short Form Power of Attorney or a non-statutory Power

of Attorney. If you have that authority, you must act according to any instructions of the principal or,

where there are no such instructions, in the principal’s best interest. You may resign by giving written

notice to the principal and to any co-agent, successor agent, monitor if one has been named in this document,

Effective 09-12-10

State of _New York

(p) SUCCESSOR AGENT'S SIGNATURE AND ACKNOWLEDGEMENT OF APPOINTMENT:

It is not required that the principal and the successor agent(s), if any, sign at the same time, nor

that multiple successor agents sign at the same time. Furthermore, successor agents cannot use this

Power of Attorney unless the agent(s) designated above is/are unable or unwilling to serve.

State of _New York

Effective 09-12-10

State of _New York

RETURN BY MAIL TO:

N.Y. Statutory Short Form Power of Attorney

N.Y. Statutory Gifts Rider

Effective 9/12/2010

Affidavit

Power of Attorney

STATE OF ___________ )

COUNTY OF ___________ ) ss:

_________________________________, being duly sworn, deposes and says as follows:

1. This affidavit is made in connection with the (transfer)(mortgage) of property known as

_________________________________________, in ____________________, New York to

_________________________________________.

2. I am (the)(an) agent named in the Power of Attorney (hereafter "Power of Attorney")

made by ________________________, as principal (the "Principal"), dated ____________.

3. I do not have actual notice that the Power of Attorney has been modified in any way that

would affect my ability to authorize or engage in the present transaction for which the

Power of Attorney is being used, or notice of any facts indicating that the Power of

Attorney has been so modified.

4. I do not have actual notice of the termination or revocation of the Power of Attorney, or

notice of any facts indicating that the Power of Attorney has been terminated or revoked,

and the Power of Attorney remains in full force and effect.

5. If the Principal has been my spouse, we are not divorced and our marriage has not been

annulled.

6. If I am a successor agent, the prior agent is no longer able or willing to serve.

______________________________________

Sworn to before me this ___ day

of ______, 20___.

________________________________________

Notary Public

NOTE: If multiple agents are appointed, an affidavit is to be executed by each agent.