General Power of Attorney

GENERAL POWER OF ATTORNEY

THIS GENERAL POWER OF ATTORNEY is given by [NAME OF PERSON GRANTING POWER] (hereinafter “Principal”), an individual residing in the County of [PRINCPAL’S COUNTY], State of [PRINCIPAL’S STATE], at [COMPLETE ADDRESS, CITY, STATE, AND ZIP CODE OF PRINCIPAL].

I, the undersigned, do hereby appoint [AGENT'S NAME - PERSON RECEIVING POWER]
of [ADDRESS, CITY, STATE, AND ZIP CODE OF AGENT] to be my true and lawful ATTORNEY-IN-FACT (hereinafter “Agent”) and do hereby revoke any and all prior powers of attorney, excepting limited powers of attorney and powers of attorney for healthcare, that have been made by me. [If my Agent is unable to serve for any reason, I designate {NAMES AND ADDRESSES OF ANY ALTERNATE AGENTS; NONE IS REQUIRED – DELETE THIS SENTENCE IF NO ALTERNATES ARE SELECTED} as my successor Agent.]

Except as otherwise specified herein, my Agent shall have full power and authority to act on my behalf and to exercise all of my legal rights and powers, including all rights and powers that I may acquire in the future. Further, I authorize my Agent to execute, acknowledge, and deliver any instrument and do all things necessary to carry out the intent hereof, hereby granting to my Agent full power and authority to act in and concerning the premises as fully and effectually as I may do if present, provided, however that all business transacted by my Agent hereunder shall be transacted in my name, and that all endorsements and instruments executed by my Agent for the purpose of carrying out the foregoing powers shall contain my name, followed by that of my Agent, and the designation “Attorney-in-Fact.”

Provided, however, my Agent shall not have the power to:

Make, publish, declare, amend, or revoke my will;
Make, execute, modify, or revoke my living will declaration or advance health care directive
Make, execute, modify, or revoke any power of attorney;
Name beneficiaries of my life insurance policies or retirement accounts;
Require me, against my will, to take any action or to refrain from taking any action; or
Carry out any actions specifically forbidden by me while not under any disability or incapacity.

[7. LIST ANY OTHER RESTRICTIONS HERE; OTHERWISE DELETE THIS SENTENCE.]
My Agent shall not be liable for any loss that results from a judgment error that was made in good faith. However, my Agent shall be liable for willful misconduct or the failure to act in good faith while acting under the authority of this Power of Attorney. I authorize my Agent to indemnify and hold harmless any third party who accepts and acts under this Power of Attorney.

My Agent shall be entitled to reimbursement of all reasonable expenses incurred in connection with this Power of Attorney, [CHOOSE ONE: and shall OR but shall not] be entitled to reasonable compensation on account of the services performed hereunder.

My Agent shall provide an accounting for all funds handled and all acts performed as my Agent, if I so request or if such a request is made by any authorized personal representative or fiduciary acting on my behalf.

The effective date of this Power of Attorney is [SPECIFY THE DATE YOU WANT THIS POWER OF ATTORNEY TO TAKE EFFECT, GENERALLY THE DATE IT IS EXECUTED. TO MAKE THE POWER OF ATTORNEY EFFECTIVE ONLY WHEN YOU BECOME INCAPACITATED, YOU MUST INSERT THE FOLLOWING LANGUAGE AND CHOOSE ONLY ‘DURABLE’ BELOW: This springing Power of Attorney shall not be effective until such time as my physician, Dr. , has determined in writing that I have become incapacitated and unable to make decisions on my own.].

This Power of Attorney [CHOOSE ONE: shall not be durable OR shall be durable and this Power of Attorney and the authority of my Agent shall not terminate if I subsequently become disabled or incapacitated]. This Power of Attorney may be revoked by me at any time by written notice to my Agent. This Power of Attorney shall automatically be revoked upon my death.

IN WITNESS WHEREOF, I have executed this Power of Attorney on this ____ day of _________, 200__.

SIGNATURE OF PRINCIPAL

PRINTED NAME OF PRINCIPAL

Witness Signature:___________________________________

Name:_____________________________________________

Address:___________________________________________

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(THIS AREA FOR NOTARY PUBLIC)

STATE OF __________________
COUNTY OF __________________

                On ______________, before me, _____________________________, a Notary Public, personally appeared _____________________________, personally known to me (or 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.

WITNESS my hand and official seal.                                              _________________________________
                                                                                                                Signature of Notary Public

My commission expires: ______________

(This area for notary seal.)

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