Form: California Statutory 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 document does 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, unless you 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 person.
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.
Date: _________________________________________________
______________________________________________________
(Signature of agent)
______________________________________________________
(Print name of agent)
NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING. 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.
I, _____________________________________________________________________________ (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)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
(J)
(K)
__________
__________
__________
(L)
(M)
(N)
Real property transactions.
Tangible personal property transactions.
Stock and bond transactions.
Commodity and option transactions.
Banking and other financial institution transactions.
Business operating transactions.
Insurance and annuity transactions.
Estate, trust, and other beneficiary transactions.
Claims and litigation.
Personal and family maintenance.
Benefits from social security, medicare, medicaid, or other governmental programs, or
civil or military service.
Retirement plan transactions.
Tax matters.
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 AGENT.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
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 of _________________________, __________.
________________________________________
(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, ____________________________________, a notary public,
personally appeared__________________________________________________________
__________________________________________________________________________
__________________________________________________________________________, 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 and correct.
WITNESS my hand and official seal.
Signature __________________________________ (Seal)