Authorize someone to make decisions on your behalf: Power of Attorney

However, the preceding sentence shall not have the effect of revoking any powers of attorney that are directly related to my health care that previously have been signed by me.

SPECIAL INSTRUCTIONS APPLICABLE TO CO-AGENTS:

The fiduciary powers that my Agent are authorized to exercise, along with the persons for whom I act as a fiduciary, are as follows:

I shall be considered disabled or incapacitated for purposes of this power of attorney if a physician certifies in writing at a date later than the date this power of attorney is executed that, based on the physician's medical examination of me, I am mentally incapable of managing my financial affairs. I authorize the physician who examines me for this purpose to disclose my physical or mental condition to another person for purposes of this power of attorney. A third party who accepts this power of attorney is fully protected from any action taken under this power of attorney that is based on the determination made by a physician of my disability or incapacity.

This power of attorney shall become effective .

If the Agent is unable to serve for any reason, I appoint , of , , , as my alternate or Successor Agent, as the case may be to serve with the same powers and discretions.

If we become legally separated or divorced, the other Agent shall serve alone.

If the Agent is my spouse, then I also hereby appoint , of , as my substitute Agent solely for the purpose of releasing any dower, homestead or other inchoate interest or other property rights (of whatever nature), which under local law may not be released by my spouse.

This power of attorney continues until I revoke it or it is terminated by my death or other event described in Subtitle P, Title 2 of the Texas Estates Code.

I agree that any third party who receives a copy of this document may act under it. Termination of this power of attorney is not effective as to a third party until the third party has actual knowledge of the termination. I agree to indemnify the third party for any claims that arise against the third party because of reliance on this power of attorney. The meaning and effect of this power of attorney is determined by Texas law.

Dated ____________________, ______, at , Texas.

__________________________________

NOMINATION OF CONSERVATOR:

If it becomes necessary for a court to appoint a conservator of my estate, I nominate the following person for appointment:

,

If the Agent is unable to serve for any reason, I appoint , of , , , as my alternate or Successor Agent, as the case may be to serve with the same powers and discretions.

If we become legally separated or divorced, the other Agent shall serve alone.

Manner of Revocation: The Principal may revoke this document in writing at any time before the expiration date for no reason or for cause, or if the Attorney-in-Fact exceeds or violates the scope and authority granted by this document. If the Principal becomes disabled or incapacitated, the Attorney-in-Fact may continue acting as such despite the disability, incapacity or the expiration date.

Manner of Revocation: The Principal may revoke this document in writing at any time before the expiration date for no reason or for cause. Also, if the Attorney-in-Fact exceeds or violates the scope and authority granted by this document, the Principal may revoke in writing the Power of Attorney at any time before the expiration date.

However, the preceding sentence shall not have the effect of revoking any powers of attorney that are directly related to my health care that previously have been signed by me.

My Agent shall have full power and authority to act on my behalf. This power and authority shall authorize my Agent to manage and conduct all of my affairs and to exercise all of my legal rights and powers, including all rights and powers that I may acquire in the future. My Agent's powers shall include, but not be limited to, the power to:

My Agent shall have full power and authority to act on my behalf but only to the extent permitted by this Special Power of Attorney. My Agent's powers shall include the power to:

.

. Conduct any business with any banking or financial institution with respect to any of my accounts, including, but not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other instruments with respect to any such accounts, obtaining bank statements, passbooks, drafts, money orders, warrants, and certificates or vouchers payable to me by any person, firm, corporation or political entity.

. Add, delete or change beneficiaries to

initials: ___________

. Perform any act necessary to deposit, negotiate, sell or transfer any note, security, or draft of the United States of America, including U.S. Treasury Securities.

. Waive my right to be a beneficiary of a joint and survivor annuity, including a survivor benefit under a retirement plan.

initials: ___________

. Have access to any safe deposit box that I might own, including its contents.

. Create or change rights of survivorship

Bank Accounts

Investment Accounts

Insurance Policies

Annuities

Retirement Plans

Other:

. Provide for the support and protection of myself, my spouse, or of any minor child I have a duty to support or have established a pattern of prior support, including, without limitation, provision for food, lodging, housing, medical services, recreation and travel.

. Purchase and/or maintain insurance and annuity contracts, including life insurance upon my life or the life of any other appropriate person.

.

. Maintain and/or operate any business that I may own.

. Employ professional and business assistance as may be appropriate, including attorneys, accountants, and real estate agents.

If the Agent is my spouse, then I also hereby appoint , of , as my substitute Agent solely for the purpose of releasing any dower, homestead or other inchoate interest or other property rights (of whatever nature), which under local law may not be released by my spouse.

. Make gifts from my assets to members of my family and to such other persons or charitable organizations with whom I have an established pattern of giving (or if it is appropriate to make such gifts for estate planning and/or tax purposes), to file state and federal gift tax returns, and to file a tax election to split gifts with my spouse, if any. No Agent acting under this instrument, except as specifically authorized in this instrument, shall have the power or authority to (a) gift, appoint, assign or designate any of my assets, interests or rights, directly or indirectly, to such Agent, such Agent's estate, such Agent's creditors, or the creditors of such Agent's estate, (b) exercise any powers of appointment I may hold in favor of such Agent, such Agent's estate, such Agent's creditors, or the creditors of such Agent's estate, or (c) use any of my assets to discharge any of such Agent's legal obligations, including any obligations of support which such Agent may owe to others, excluding those whom I am legally obligated to support.

initials: ___________

. To transfer any of my assets to the trustee of any revocable trust created by me, if such trust is in existence at the time of such transfer.

. To utilize my assets to fund a trust not created by me, but to which I have either established a pattern of funding, or to fund a trust created by my Agent for my benefit or the benefit of my dependents, heirs or devisees upon the advice of a financial adviser.

initials: ___________

. To create, sign, modify or revoke any trust agreements or other trust documents in an attempt to manage or create a trust that was created for my benefit or the benefit of my dependents, heirs or devisees. This shall include the creation, modification or revocation of any inter vivos, family living, irrevocable or revocable trusts.

initials: ___________

. To exercise fiduciary responsibilities that I have a right to delegate.

. Subject to other provisions of this document, my Agent may disclaim any interest, which might otherwise be transferred or distributed to me from any other person, estate, trust, or other entity, as may be appropriate. However, my Agent may not disclaim assets to which I would be entitled, if the result is that the disclaimed assets pass directly or indirectly to my Agent or my Agent's estate.

initials: ___________

. Have access to my healthcare and medical records and statements regarding billing, insurance and payments.

. Act on my behalf for the purposes of managing, distributing, and terminating my digital assets. For the purposes of this Power of Attorney, digital assets shall mean electronic assets that are stored on my computers, electronic devices, or on any online account, as identified in the Digital Assets Memorandum of this Power of Attorney. Online accounts include, but are not limited to, social-networking sites, online backup services, servers, email accounts, photo and document sharing sites, financial and business accounts, domain names, virtual property, websites, and blogs. The Digital Assets Memorandum, with associated websites, usernames, passwords, and related information, is hereby incorporated by reference into this Power of Attorney and shall be distributed to my Agent designated in this Power of Attorney. My Agent shall have the power and authority to manage, conduct, and to exercise all of my legal rights and powers relating to my digital assets, including all rights and powers that I may acquire in the future. My Agent's powers shall include, but not be limited to, the power to access, download, and backup digital assets, convert my file formats, access any and all devices necessary to manage digital assets, and clear computer caches and delete files.

. Open, maintain or close bank accounts (including, but not limited to, checking accounts, savings accounts, and certificates of deposit), brokerage accounts, retirement plan accounts, and other similar accounts with financial institutions. This power shall include the authority to conduct any business with any banking or financial institution with respect to any of my accounts, including, but not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other instruments with respect to any such accounts, obtaining bank statements, passbooks, drafts, money orders, warrants, and certificates or vouchers payable to me by any person, firm, corporation, or political entity.

. Open, maintain or close the following specific accounts. This power shall include the authority to conduct any transaction for these accounts, including, but not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other instruments with respect to any such accounts, obtaining bank statements, passbooks, drafts, money orders, warrants, and certificates or vouchers payable to me by any person, firm, corporation, or political entity.

Perform any act necessary to deposit, negotiate, sell, or transfer any note, bond, security, or draft of the United States of America, including U.S. Treasury Securities.

Institute, supervise, prosecute, defend, intervene in, abandon, compromise, arbitrate, settle, dismiss, and appeal from any and all legal, equitable, judicial or administrative hearings, actions, suits, proceedings, attachments, arrests or distresses, involving me in any way.

The total sale price must be at least .

This power shall include the power to (i) sell upon such terms as my Agent shall deem appropriate, subject to the limitations (if any) stated above, (ii) sign any documents (including deeds) that may be required to convey title to such property (including changing tenancy regarding right of survivorship), and (iii) collect and receive the proceeds from any such sale.

initials: ___________

If the Agent is my spouse, then I also hereby appoint of , , as my substitute Agent solely for the purpose of releasing any dower, homestead or other inchoate interest or other property rights (of whatever nature), which under local law may not be released by my spouse.

The mortgage amount shall not exceed .

If the Agent is my spouse, then I also hereby appoint of , , as my substitute Agent solely for the purpose of releasing any dower, homestead or other inchoate interest or other property rights (of whatever nature), which under local law may not be released by my spouse.

This power shall include the power to (i) sign contracts of sale and documents to transfer title (including bills of sale), and (ii) accept a security interest for any unpaid portion of the purchase price.

This power shall include the power to (i) obtain credit upon such terms as my Agent may deem appropriate, subject to the limitations (if any) stated above, (ii) sign any documents (including notes, credit agreements, security agreements, and financing statements), and (iii) take any other action that may be required to complete the above transactions.

, , .

This power shall include the power to: (i) make and carry out decisions regarding sales, purchases, employees, loans, and equipment, and (ii) take any action needed (at the discretion of my Agent) to operate the business.

This power shall be limited to the power to make decisions in the ordinary course of business, including, but not limited to, decisions regarding sales, purchases, employees, and equipment.

, including, but not limited to, authorization to: . , including, but not limited to, authorization to: . , including, but not limited to, authorization to: .

. Prepare, sign, and file income, gift and other tax returns of all kinds with federal, state, local, and other governmental bodies, and any Power of Attorney form appointing an Agent required by the Internal Revenue Service and/or any state or local taxing authority.

. Obtain information or documents from any government or its agencies, and represent me in all tax matters, including the authority to negotiate, compromise, or settle any matter with such government or agency.

. Prepare applications, provide information, and perform any other act reasonably requested by any government or its agencies in connection with governmental benefits (including medical, military and social security benefits), and to appoint anyone, including my Agent, to act as my "Representative Payee" for the purpose of receiving Social Security benefits.

initials: ___________

initials: ___________

initials: ___________

initials: ___________

initials: ___________

, including any power of appointment, including any power of appointment, including any power of appointment

initials: ___________

Act on my behalf for the purposes of managing, distributing, and terminating my digital assets. For the purposes of this Power of Attorney, digital assets shall mean electronic assets that are stored on my computers, electronic devices, or on any online account, as identified in the Digital Assets Memorandum of this Power of Attorney. Online accounts include, but are not limited to, social-networking sites, online backup services, servers, email accounts, photo and document sharing sites, financial and business accounts, domain names, virtual property, websites, and blogs. The Digital Assets Memorandum, with associated websites, usernames, passwords, and related information, is hereby incorporated by reference into this Power of Attorney and shall be distributed to my Agent designated in this Power of Attorney. My Agent shall have the power and authority to manage, conduct, and to exercise all of my legal rights and powers relating to my digital assets, including all rights and powers that I may acquire in the future. My Agent's powers shall include, but not be limited to, the power to access, download, and backup digital assets, convert my file formats, access any and all devices necessary to manage digital assets, and clear computer caches and delete files.

Bank Accounts

Investment Accounts

Insurance Policies

Annuities

Retirement Plans

Other:

I hereby grant to my Agent the full right, power, and authority to do every act, deed, and thing necessary or advisable to be done regarding the above powers, as fully as I could do if personally present and acting.

Any power or authority granted to my Agent under this document shall be limited, to the extent necessary, to prevent this Power of Attorney from causing, (i) my income to be taxable to my Agent, (ii) my assets to be subject to a general power of appointment by my Agent, or (iii) my Agent to have any incidents of ownership with respect to any life insurance policies that I may own on the life of my Agent.

No person who relies in good faith on the authority of my Agent under this instrument shall incur any liability to me, my estate or my personal representative. I authorize my Agent to indemnify and hold harmless any third party who accepts and acts under this document.

If any part of any provision of this instrument shall be invalid or unenforceable under applicable law, such part shall be ineffective to the extent of such invalidity only, without in any way affecting the remaining parts of such provision or the remaining provisions of this instrument.

My Agent shall have the right by written instrument to delegate any or all of the foregoing powers involving discretionary decision-making to any person or persons whom my Agent may select, but such delegation may be amended or revoked by any Agent (including any Successor) named by me who is acting under this Power of Attorney at the time of reference.

I hereby appoint

This Power of Attorney shall become effective immediately. on . upon written certification by my physician that I am incapacitated or mentally incapable of managing my financial affairs, and shall not be affected by my disability or lack of mental competence, except as may be provided otherwise by an applicable state statute. This is a Durable Power of Attorney. immediately, and shall not be affected by my disability or lack of mental competence, except as may be provided otherwise by an applicable state statute. This is a Durable Power of Attorney. on , and shall not be affected by my disability or lack of mental competence, except as may be provided otherwise by an applicable state statute. This is a Durable Power of Attorney. This Power of Attorney shall continue effective until or until I lack sufficient mental competence to understand and handle my financial and personal affairs or until I lack sufficient mental competence to understand and handle my financial and personal affairs. This Power of Attorney may be revoked by me at any time by providing written notice to my Agent.

This Power of Attorney shall become effective This Power of Attorney shall continue to be effective until or until I lack sufficient mental competence to understand and handle my financial and personal affairs or until I lack sufficient mental competence to understand and handle my financial and personal affairs

This Power of Attorney shall become effective immediately. on . upon written certification by my physician that I am incapacitated or mentally incapable of managing my financial affairs, and shall not be affected by my disability or lack of mental competence, except as may be provided otherwise by an applicable state statute. This is a Durable Power of Attorney. immediately, and shall not be affected by my disability or lack of mental competence or in the event of later uncertainty as to whether I am dead or alive, except as may be provided otherwise by an applicable state statute. This is a Durable Power of Attorney. on , and shall not be affected by my disability or lack of mental competence, except as may be provided otherwise by an applicable state statute. This is a Durable Power of Attorney. This Power of Attorney shall continue effective until or until I lack sufficient mental competence to understand and handle my financial and personal affairs or until I lack sufficient mental competence to understand and handle my financial and personal affairs

DESIGNATION OF SUCCESSOR AGENT(S)

If the Agent is unable to serve for any reason, I appoint , of , , , as my alternate or Successor Agent, as the case may be to serve with the same powers and discretions.

If we become legally separated or divorced, the other Agent shall serve alone.

This Power of Attorney shall not be affected by my subsequent incapacity.

This Power of Attorney DOES NOT REVOKE any Powers of Attorney previously executed by me.

However, the preceding sentence shall not have the effect of revoking any powers of attorney that are directly related to my health care that previously have been signed by me.

Dated ____________________, ______, at , .

Dated ____________________, ______, at , County, .

I, , the principal, sign my name to this Power of Attorney this _____ day of __________ and, being first duly sworn, do declare to the undersigned authority that I sign and execute this instrument as my power of attorney and that I sign it willingly, or willingly direct another to sign for me, and that I execute it as my free and voluntary act for the purposes expressed in the Power of Attorney, and that as required by A.R.S. § 14-5501, and that I am eighteen years of age or older, of sound mind and under no constraint or undue influence.

The principal is personally known to me and I believe the principal to be of sound mind. I am eighteen (18) years of age or older. I am not related to the principal by blood or marriage, or related to the attorney-in-fact by blood or marriage. The principal has declared to me that this instrument is his or her Power of Attorney granting to the named attorney-in-fact the power and authority specified in this document, and that he or she has willingly made and executed it as his or her free and voluntary act for the purposes expressed in this document.

I, , the witness, sign my name to the foregoing Power of Attorney, being first duly sworn, and do declare to the undersigned authority that the principal signs and executes this instrument as his/her Power of Attorney and that he/she signs it willingly, and that I, in the presence and hearing of the principal, sign this Power of Attorney as witness to the principal's signing and that to the best of my knowledge the principal is eighteen years of age or older, of sound mind and under no constraint or undue influence.

We, and , the witnesses, sign our name to the foregoing Power of Attorney, being first duly sworn, and do declare to the undersigned authority that the principal signs and executes this instrument as his/her Power of Attorney and that he/she signs it willingly, and that we, in the presence and hearing of the principal, sign this Power of Attorney as witnesses to the principal's signing and that to the best of our knowledge the principal is eighteen years of age or older, of sound mind and under no constraint or undue influence.

We, the undersigned, hereby certify that the above instrument, which consists of _______ pages, including the pages(s) which contain the witness signatures, was signed in our sight and the presence by (the "Principal"), who declared this instrument to be his/her Power of Attorney and we, at the Principal's request and in the Principal's sight and presence, and in the sight and presence of each other, do hereby subscribe our names as witnesses on the date shown above.

The foregoing power of attorney was, on the date written above, published and declared by in our presence to be his/her power of attorney. We, in his/her presence and at his/her request, and in the presence of each other, have attested to the same and have signed our names as attesting witnesses.

(may not be the Agent, the Agent's spouse or child, or the Notary Public)

(witnesses may not be under 18 or related by blood or marriage to the principal or to the Agent)

(witnesses must be adults and at least one may not be related by blood or marriage to the principal)

STATE OF ,

DISTRICT OF COLUMBIA, ss:

The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by , who is personally known to me or who has produced ________________________________ as identification.

Before me, a Notary Public (or justice of the peace) in and for said county, personally appeared the above named , ________________________________, and ________________________________, who acknowledged that they did sign the foregoing instrument, and that the same is their free act and deed. In testimony whereof, I have hereunto subscribed my name at ________________________________, this _____ day of ____________________, ______.

The foregoing instrument was acknowledged before me this _____ day of ____________________, ______, by , , and .

The foregoing instrument was acknowledged before me, by means of ☐ physical presence or ☐ online notarization, this _____ day of ____________________, ______ by , who is personally known to me or who has produced ________________________________ as identification.

This instrument was acknowledged before me on this _____ day of ____________________, ______ by .

Subscribed, sworn to and acknowledged before me by , the principal, and subscribed and sworn to before me by , witness, this ________ day of _____________.

Before me, the undersigned authority, on this ______day of _________________, ______, personally appeared (principal), (witness), and (witness), whose names are signed to the foregoing instrument in their respective capacities, and all of these persons being by me duly sworn, the principal declared to me and to the witnesses in my presence that the instrument is his or her Power of Attorney, and that the principal has willingly and voluntarily made and executed it as the free act and deed of the principal for the purposes expressed in the document, and the witnesses declared to me that they were each eighteen (18) years of age or over, and that neither of them is related to the principal by blood or marriage, or related to the attorney-in-fact by blood or marriage.

On this _____ day of ____________________, ______, before me personally appeared , to me known to be the person described in and who executed the foregoing instrument, and acknowledged that he/she executed same as his/her free act and deed.

On this _____ day of ____________________, ______, before me, ________________________________, personally appeared , known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he/she executed the same as for the purposes therein contained.

On this _____ day of ____________________, ______, before me, the undersigned, Notary Public for the State of Vermont, personally appeared , to me known (or to me proved) to be the identical person named in and who executed the above General Power of Attorney, and acknowledged that such person executed it as such person's voluntary act and deed.

The foregoing instrument was acknowledged before me this _____ day of ____________________, ______, by .

In witness whereof, I hereunto set my hand and official seal.

Signature of person taking acknowledgment

Notary Public

_________________________________

Name typed, printed, or stamped

My commission expires _____________

Notary Address:

_________________________________

_________________________________

_________________________________

_________________________________

I shall act in accordance with the principal's reasonable expectations to the extent actually known by me and, otherwise, in the principal's best interest, act in good faith and act only within the scope of authority granted to me by the principal in the power of attorney.

This Power of Attorney must be dated and must be acknowledged before a notary public must be mentally competent and they must witness the principal's signing of the Power of Attorney or (2) the principal's signing or acknowledgment of his or her signature. A Power of Attorney that may affect real property should be acknowledged before a notary public so that it may easily be recorded.

This Power of Attorney must be dated and must be acknowledged before a notary public and signed by two witnesses. Both witnesses and the principal must be mentally competent adults, and the witnesses should actually watch the principal sign the Power of Attorney.

Digital Agent's Name Printed

,

Digital Agent's Address

Digital Agent's Telephone Number

Co-Digital Agent's Name Printed

,

Co-Digital Agent's Address

Co-Digital Agent's Telephone Number

,

Dated: ________________________

Signed: _______________________________________

Dated: ________________________

Signed: _______________________________________

Name of Digital Agent:

Address:

City:

State:

Postal Code:

Phone Number:

Name of Digital Agent:

Address:

City:

State:

Postal Code:

Phone Number:

Name of First Co-Digital Agent:

Address:

City:

State:

Postal Code:

Phone Number:

Name of First Co-Digital Agent:

Address:

City:

State:

Postal Code:

Phone Number:

Name of Second Co-Digital Agent:

Address:

City:

State:

Postal Code:

Phone Number:

Name of Second Co-Digital Agent:

Address:

City:

State:

Postal Code:

Phone Number:

Your digital assets memorandum should be separated from the rest of the Power of Attorney and be accessible only to the Principal and the Agent(s).

Your Agents and Successor Agents should read and sign the notices provided so they understand their responsibilities.

If you elected to allow your Agent to make gifts exceeding $500.00 per individual in a calendar year, the signing of your Power of Attorney must be witnessed by two (2) witnesses in addition to a notary public in order for this provision to be valid.

Carefully review the Statutory Gift Rider and initial power you wish to grant your agent. The powers contained in the Statutory Gift Rider will not be granted until each power is initialed and the document is signed and witnessed.

Both witnesses must watch the Principal sign this Power of Attorney. The Principal should verbally declare that the document is intended to be his or her Power of Attorney, but the witnesses need not read the Power of Attorney or know of its contents.

Each witness must sign his or her name with the Principal and the other witness present. The witnesses should be satisfied that the Principal willingly signed the document as a free and voluntary act, and that the Principal was of full age and sound mind.

The Power of Attorney must be recorded in the office of the County Recorder.

The name of the person who prepared the Power of Attorney document must be indicated in the document in order for it to be recorded.

The witnesses must be adults and cannot be the Agent, the Agent's spouse or children, or the notary public.

The Power of Attorney must be registered in the office of the register of deeds in order for it to be effective after the principal becomes incompetent. Until then, registration is unnecessary.

If you plan to register this document, you will need to manually change the margins of your document to fit the recording requirements. The first page should have a 3 inch top margin and a 1/4 inch margin on all other sides. All subsequent pages should have a 1/4 inch margin on all sides. For more information please visit: http://www.secretary.state.nc.us/ahcdr/.

If the Principal is unable to sign due to a physical disability, another person may be able to sign on behalf of the Principal, in the Principal's presence, and at the express direction of the Principal. However, this document does not provide the necessary language for another person to sign for the Principal. For assistance with this procedure, a lawyer should be contacted.

Your digital assets have changed.