Fillable Printable Uniform Statutory Power of Attorney Form - California

Uniform Statutory Power of Attorney Form - 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 LATER IF YOU WISH TO DO SO.

I, _____________________________________________________ (your name and address) appoint

__________________________________________________________ (name and address of the

person appointed, or of each person appointed if you want to designate more than one) 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 MARKED WITH A (N) AND

IGNORE THE LINES IN FRON 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.

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.

_________ (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:

____________________________________________________________________________________

UNLESS YOU DIRECT OTHERWISE ABOVE, THIS POWER OF ATTORNEY IS EFFECTIVE

IMMEDIATELY AND WILL CONTINUE UNTIL IT IS REVOKED EVEN THOUGH YOU BECOME

INCAPACITATED.

This power of attorney will continue to be effective even 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 effect as to a third party until the third party has actual knowledge of revocation. I

agree to indemnify the third party for any claims that arise against the third party because of reliance on

this power of attorney.

Signed this __________ day of _______________________, 19________.

__________________________________

(your signature)

___________________________________

(your social security number)

BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT ASSUMES THE FIDUCIARY

AND OTHER LEGAL RESPONSIBILITIES OF AN AGENT.

CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC

STATE OF CALIFORNIA )

COUNTY OF _____________________ )

On _______________________, before me, ________________________________, the undersigned

notary public in and for the State of California, personally appeared

____________________________________, 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.

WITNESS my hand and official seal.

_____________________________________

Signature of Notary Public

My commission expires ___________________