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HomeMy WebLinkAbout877235LF205-04 GENERAL POWER OF ATTORNEY (With Durable Provisiou) NOTICE: THIS IS AN IMPORTANT~DOCUMENT. BEFORE SIGNING THIS DOCU- MENT, YOU SHOULD KNOW THESE IMPORTANT FACTS. THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON WHOM YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO PLEDGE, SELL OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. YOU MAY SPECIFY THAT THESE POWERS WILL EXIST EVEN AFTER YOU BECOME DISABLED, INCAPACITATED OR INCOMPETENT. THIS DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL OR OTHER HEALTH CARE DECISIONS FOR YOU. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU. SItOULD ASK A LAWYER TO EXPLAIN IT TO YOU. YOU MAY REVOKE THIS POWER OF ATTORNEY IF YOU LATER WISH TO DO SO. TO ALL PERSONS, be it known that [, ~ ~qD~ ~', '~ E~ of , the undersigned ,Grantor, do hereb~ make and grant a general power of attorney to and do thereupon constitute and appoint said individual as my attorney-in-fact/agent. My attorney-in-facffagent shall act in my name, place and stead in any way which I myself could do, if I were personally present, with respect to the following matters, to the extent that I am permitted by law to act through an agent: (NOTICE: The grantor must write his or her initials in the corresponding blank space of a box below with respect to each of the subdivisions (A) through (O) below for which the Grantor wants to give the agent authority. If the blank space within a box for any particular subdivision is NOT initialed, NO AUTHORITY WILL BE GRANTED for mat- ters that are included in that subdivision. Cross out each power withheld.) [ ~¢p ] (A) Real estate transactions qa ~~ gdbdCgi~}O~, [ .........] (B) Tangible personal property transactions ~-- ~ (C) Bond, share and commodity transaciions [~ rD) Banking transactions [~] rE) Business operating transactions ~ (F) Insurance transactions [~ ' (G) Gifts to charities and individuals other than Attorney-in-Fact/Agent (If trust distributiuns are involved or tax consequences are anticipated, consult an attorney.) © 1992 2001 E-Z Legal Forms, Inc. Page 1 ' Res,. 03/0[ This producI: does :lot constilute the rendering of legal advice or services. This product is intended for informational use oaly and is not a substitute for legal advice. State laws vary, so consult au attorney on all legal matters. This product was trot necessarily prepared by a person licensed to practice law in your state. 689 [. ......] ....... (H) Chdms and litigation · [- ...... -}- (I) Personal relationships and affairs [ .... ~'- ' (J) Benefits from military service ,~ .... q (K) Rec6rds reports and statements [-- ..... } (L) Full and unqualified authority to my attorney-in-fact/agent to delegate any or all of the fore- going powers to any person or persons whom my attorney-in-fact/agent shall select [ ...... :}- (M) Access to safe deposit box(es) [~---]- (N) To au.tbOrize medical and surgical procedures (Pennsylvania only) [- ----°F (O) All other matters Durable Provision: [- ] - (P) It' ~lie blank space in the block to the left is initialed by the Grantor, tiffs power o~ attor- ney shrill not be affected by the subsequent disability or incompetence of the Grantor. Other Terms: , My attorney-in-fact/agent hereby accepts this appointment subject to its terms and agrees to act and perform, in said fiduciary capacity consistent with my best interests as he/she in his/her best discretion deems advisable, and I affirm and ratify all acts so undertaken. TO INDUCE ANY THIRD PARTY TO ACT HEREUNDER, I HEREBY AGREE THAT ANY THIRD PARTY RECEIVING A DULY EXECUTED COPY OR FACSIMILE OF THIS INSTRUMENT MAY ACT HEREUNDER, AND THAT REVOCATION OR TERMINATION HEREOF SHALL BE INEF- FECTIVE AS TO SUCH THIRD PARTY UNLESS AND UNTIL ACTUAL NOTICE OR KNOWLEDGE OF SUCH REVOCATION OR TERMINATION SHALL HAVE BEEN RECEIVED BY SUCH THIRD PARTY, AND I FOR MYSELF AND FOR MY HEIRS, EXECUTORS, LEGAL REPRESENTATIVES AND ASSIGNS, HEREBY AGREE TO INDEMNIFY AND HOLD HARMLESS ANY SUCH THIRD PARTY FROM AND AGAINST ANY AND ALL CLAIMS THAT MAY ARISE AGAINST SUCH THIRD PARTY BY REASON OF SUCH THIRD PARTY }lAVING RELIED ON THE PRO~ISI, ONS OF THIS INSTRUMENT. Signed nnder seal this 2&~ dayof Signed in the presence of: " ~V~mess , 0 Grantor State of oun¢ of On 5~ ~ ~,~] before lne, ~d~ ~ P~ , 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/ghe/they executed the same in his/her/their authorized capac- and that by his/hedtheir signature(s)~e person(s), Or the entity upon behalf of which the ity(ies), pm'son(s, actgd, ~xecuted the instrmnm, t. /~~Z~ ' WITNESS my hand and official seal. ~" ~,_ '~ . Slgllaltlre~~ ~, ~ ~ff_~ ~,g Affiant _____Knowu~Produced ID Page 2