GENERAL (FINANCIAL) POWER OF ATTORNEY

IMPORTANT INFORMATION

This Power of Attorney authorizes another person (your agent) to make decisions concerning your property for you (the principal). Your agent will be able to make decisions and act with respect to your property (including your money) whether or not you are able to act for yourself.

This power of attorney does not authorize the agent to make health-care decisions for you.

You should select someone you trust to serve as your agent. Unless you specify otherwise, generally the agent’s authority will continue until revoke the power of attorney or the agent resigns or is unable to act for you.

DESIGNATION OF AGENT

I, __________________________________________________ name the following person as my agent: __________________________________________________ .

DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)

If my agent is unable or unwilling to act for me, I name as my successor agent:

Name of Successor: _____________________________________________________
Successor Agent’s Address: _______________________________________________
Successor Agent’s Telephone Number: ______________________________________

If my successor agent is unable or unwilling to act for me, I name as my second successor agent:

Name of Second Successor Agent: _________________________________________
Second Successor Agent’s Address: ________________________________________
Second Successor Agent’s Telephone Number: _______________________________

GRANT OF GENERAL AUTHORITY

I grant my agent and any successor agent general authority to act for me with respect to the following subjects as defined in _________ (State Law).

(CHECK each subject you want to include in the agent’s general authority. If you wish to grant general authority over all of the subjects you may check “All Preceding Subjects” instead of checking each subject.)

☐ Real Property
☐ Tangible Personal Property
☐ Stocks and Bonds
☐ Commodities and Options
☐ Banks and Other Financial Institutions
☐ Operation of Entity or Business
☐ Insurance and Annuities
☐ Estates, Trusts, and Other Beneficial Interests
☐ Claims and Litigation
☐ Personal and Family Maintenance
☐ Benefits from Governmental Programs or Civil or Military Service
☐ Retirement Plans
☐ Taxes

☐ All Preceding Subjects

GRANT OF SPECIFIC AUTHORITY (OPTIONAL)

My agent MAY NOT do any of the following specific acts for me UNLESS I have CHECKED the specific authority listed below: (CAUTION: Granting any of the following will give your agent the authority to take actions that could significantly reduce your property or change how your property is distributed at your death. CHECK ONLY the specific authority you WANT to give your agent.)

☐ Create, amend, revoke, or terminate an inter vivos trust
☐ Make a gift, subject to the limitations of the Uniform Power of Attorney Act and any special instructions in this power of attorney
☐ Create or change rights of survivorship
☐ Create or change a beneficiary designation
☐ Authorize another person to exercise the authority granted under this power of attorney
☐ Waive the principal’s right to be a beneficiary of a joint and survivor annuity, including a survivor benefit under a retirement plan
☐ Exercise fiduciary powers that the principal has authority to delegate
☐ Disclaim or refuse an interest in property, including a power of appointment
LIMITATION ON AGENT’S AUTHORITY

An agent that is not my ancestor, spouse, or descendant MAY NOT use my property to benefit the agent or a person to whom the agent owes an obligation of support unless I have included that authority in the Special Instructions.

SPECIAL INSTRUCTIONS (OPTIONAL)

You may give special instructions on the following lines:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
EFFECTIVE DATE

This power of attorney is effective immediately unless I have stated otherwise in the Special Instructions.

NOMINATION OF CONSERVATOR OR GUARDIAN (OPTIONAL)

If it becomes necessary for a court to appoint a conservator or guardian of my estate or guardian of my person, I nominate the following person(s) for appointment:
Name of Nominee for conservator or guardian of my estate:
______________________________________________________________________
Nominee’s Address: __________________________________________________
Nominee’s Telephone Number: ____________________________________________
Name of Nominee for guardian of my person: _________________________________
Nominee’s Address: _____________________________________________________
Nominee’s Telephone Number: _____________________________________
RELIANCE ON THIS POWER OF ATTORNEY

Any person, including my agent, may rely upon the validity of this power of attorney or a copy of it unless that person knows it has terminated or is invalid.

SIGNATURE AND ACKNOWLEDGMENT

Your Signature: __________________________________________ Date: _________

Your Printed Name: _____________________________________________________

Your Address: __________________________________________________________
Your Telephone Number: _____________________________________

STATEMENT OF WITNESS

On the date written above, the principal declared to me in my presence that this instrument is his general durable power of attorney and that he or she had willingly signed or directed another to sign for him or her, and that he or she executed it as his or her free and voluntary act for the purposes therein expressed.

WITNESS No. 1

Signature: _____________________________________________________________

Printed Name: __________________________________________________________

Address: ______________________________________________________________
WITNESS No. 2:

Signature: _____________________________________________________________

Printed Name: __________________________________________________________

Address: ______________________________________________________________
CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC

State of ________________________
County of _______________________

Acknowledged before me this _____ day of _______________ (month), 20___(year) by _________________________________ (name of principal). The affiant is (choose one): ☐ personally known to me, or ☐ produced the following identification:
__________________________________________________________________

Signature of Notary: _____________________________________________________
My commission expires: __________________________

(Seal, if any)