Uniform Statutory Form Power of Attorney Uniform Statutory Form Power
of Attorney (California Probate Code Section 4401) Notice to Person Executing
Durable Power of Attorney A durable power of attorney is an important legal
document. By signing the durable power of attorney, you are authorizing another
person to act for you, the principal. Before you sign this durable power of attorney,
you should know these important facts: Your agent (attorney-in-fact) has no duty
to act unless you and your agent agree otherwise in writing.
This document gives your agent the powers to manage, dispose of, sell, and convey
your real and personal property, and to use your property as security if your agent
borrows money on your behalf. This documentdoes not give your agent the power
to accept or receive any of your property, in trust or otherwise, as a gift,unless you
specifically authorize the agent to accept or receive a gift. Your agent will have the
right to receive reasonable payment for services provided under this durable power
of attorney unless you provide otherwise in this power of attorney. The powers you
give your agent will continue to exist for your entire lifetime, unlessyou state that
the durable power of attorney will last for a shorter period of time or unless you
otherwise terminate the durable power of attorney. The powers you give your agent
in this durable power of attorney will continue to exist even if you can no longer make
your own decisions respecting the management of your property. You can amend or
change this durable power of attorney only by executing a new durable power of
attorney or by executing an amendment through the same formalities as an original.
You have the right to revoke or terminate this durable power of attorney at any time,
so long as you are competent. This durable power of attorney must be dated and
must be acknowledged before a notary public or signed by two witnesses. If it is signed
by two witnesses, they must witness either (1) the signing of the power of attorney or (2)
the principal’s signing or acknowledgment of his or her signature. A durable power of
attorney that may affect real property should be acknowledged before a notary public
so that it may easily be recorded. You should read this durable power of attorney carefully.
When effective, this durable power of attorney will give your agent the right to deal with
property that you now have or might acquire in the future. The durable power of attorney
is important to you. If you do not understand the durable power of attorney, or any
provision of it, then you should obtain the assistance of an attorney or other qualified
Notice to Person Accepting the Appointment as Attorney-in-Fact By acting or agreeing to
act as the agent (attorney-in-fact) under this power of attorney you assume the fiduciary
and other legal responsibilities of an agent. These responsibilities include:
1. The legal duty to act solely in the interest of the principal and to avoid conflicts of
interest. 2.The legal duty to keep the principal’s property separate and distinct from any other property owned or controlled by you. You may not transfer the principal’s property to yourself without full and adequate consideration or accept a gift of the principal’s property unless this power of attorney specifically authorizes you to transfer property to yourself or accept a gift of the principal’s property. If you transfer the principal’s property to yourself without specific authorization in the power of attorney, you may be prosecuted for fraud and/or embezzlement. If the principal is 65 years of age or older at the time that the property is transferred to you without authority, you may also be prosecuted for elder abuse under Penal Code Section 368. In addition to criminal prosecution, you may also be sued in civil court. I have read the foregoing notice and I understand the legal and fiduciary duties that I assume by acting or agreeing to act as the agent (attorney-in-fact) under the terms of this power of attorney.
(Signature of agent) __________________________________________________
(Print name of agent) _________________________________________________
NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND
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 HEALTHCARE DECISIONS FOR YOU. YOU MAY REVOKE THIS POWER
OF ATTORNEY IF YOU LATER WISH TO DO SO.
(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 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.
__________ (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
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 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 I have designated more than one agent, the agents are to act _________________.
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 third party for any claims that arise against the third party because of reliance on this power of attorney.
Signed this __________ day
(your signature) ________________________________________
(your Social Security number) State of ________________________,
County of _________________________,
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, (here insert name and title of the officer),
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true andcorrect. WITNESS my hand and official seal.
Signature __________________________________ (Seal)
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