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Fillable Printable Uniform Statutory Form Power of Attorney - California

Fillable Printable Uniform Statutory Form Power of Attorney - California

Uniform Statutory Form Power of Attorney - California

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 UNIFORM 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, , who currently reside at
appoint
,who currently resides at
or if that person
is no longer willing or able, who currently resides at
or if that person
is no longer willing or able who currently resides at
as my agent
(attorney-in-fact) to act for me in any lawful way with respect to the following
initialed subjects:
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 POWER 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 WITHHELD.
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INITIAL
(A) Real Property transactions
(B) Tangible personal property transactions.
(C) Stock and bond transactions.
(D) Commodity and option transactions.
(E) Banking and other financial institution transactions.
(F) Business operating transactions.
(G) Insurance and annuity transactions.
(H) Estate, trust, and other beneficiary transactions.
(I) Claims and litigation.
(J) Personal and family maintenance.
(K) Benefits from social security, 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).
SPECIAL INSTRUCTIONS:
ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL
INSTRUCTIONS LIMITING OR EXTENDING THE POWERS GRANTED TO
YOUR AGENT.
A. The powers granted my agent herein shall only be effective upon my
incapacity.
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B. For purposes of this Power of Attorney, incapacity, shall be determined
by two licensed physicians not related to me or any of my nominated
agents by blood or marriage pursuant to California Probate Code
Sections 4129 and 4405.
C. My agent shall cooperate with my lawfully appointed agent for health
care under my Advance Health Care Directive or any party making
health care decisions for me by releasing funds from my estate if
necessary to pay for any treatment or care lawfully designated by my
agent for health care.
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 though I become
incapacitated.
STRIKE THE PRECEDING SENTENCE IF YOU DO NOT WANT THIS
POWER OF ATTORNEY TO CONTINUE IF YOU BECOME INCAPACITATED.
EXERCISE OF POWER OF ATTORNEY WHERE
MORE THAN ONE AGENT DESIGNATED
IF YOU APPOINTED MORE THAN ONE AGENT AND YOU WANT
EACH AGENT TO BE ABLE TO ACT ALONE WITHOUT THE OTHER AGENT
JOINING, 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. 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 indemnify the
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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)
(your social security number)
State of California,
County of ______________
BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT
ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES OF AN
AGENT.
CERTIFICATE OF ACKNOWLEDGMENT
STATE OF CALIFORNIA )
COUNTY OF _________________ )
On ___________________, before me, ,
a notary public, personally appeared who proved
to me on the basis of satisfactory evidence to be the person whose name is subscribed
to the within instrument and acknowledged to me that he/she executed the same in
his/her authorized capacity, and that by his/her signature on the instrument the
person, or the entity upon behalf of which the person acted executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California
that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature____________________________________
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