Oregon Durable Power of Attorney Form

OREGON
DURABLE POWER OF ATTORNEY FORM
I. NOTICE - This legal document grants you (Hereinafter referred to as the
“Principal”) the right to transfer unlimited financial powers to someone else
(Hereinafter referred to as the “Attorney-in-Fact”), unlimited financial powers
are described as: all financial decision making power legal under law. The
Principal’s transfer of financial powers to the Attorney-in-Fact are granted
upon authorization of this agreement, and stay in effect in the event of
incapacitation by the Principal (incapacitation is described in Paragraph II).
This agreement does not authorize the Attorney-in-Fact to make medical
decisions for the Principal. The Principal continues to retain every right to all
their financial decision making power and may revoke this Durable Power of
Attorney Form at anytime. The Principal may include restrictions or requests
pertaining to the financial decision making power of the Attorney-in-Fact. It is
the intent of the Attorney-in-Fact to act in the Principal’s wishes put forth, or,
to make financial decisions that fit the Principal’s best interest. All parties
authorizing this agreement must be at least 18 years of age and acting under
no false pressures or outside influences. Upon authorization of this Durable
Power of Attorney Form, it will revoke any previously valid Durable Power of
Attorney Form.
II. INCAPACITATION – The powers granted to the Attorney-in-Fact by the
Principal in this Durable Power of Attorney Form stay in effect upon
incapacitation by the Principal, incapacitation is describes as: A medical
physician stating verbally or in writing that the Principal can no longer make
decisions for them self.
III. REVOCATION - The Principal has the right to revoke this Durable Power of
Attorney Form at anytime. Any revocation will be effective if the Principal
either:
A. Authorizes a new Durable Power of Attorney Form.
B. Authorizes a Power of Attorney Revocation Form.
IV. WITNESS & NOTARY - This document is not valid as a Durable Power of
Attorney unless it is acknowledged before a notary public or is signed by at
least two adult witnesses who are present when the Principal signs or
acknowledges the Principal’s signature. It is recommended to have this
Durable Power of Attorney Form notarized.
V. PRINCIPAL - I,
, residing at
Name of Principal
Street Address of Principal
City of
, State of
, appoint
City of Principal
State of Principal
the following as my Attorney-in-Fact, whom I trust with any and all my
financial decision making power immediately upon the authorization of this
form, and in the event that I should become incapacitated:
VI. ATTORNEY-IN-FACT -
, residing at
Name of Attorney-in-Fact
Street Address of Attorney-in-Fact
City of
, State of
City of Attorney-in-Fact
grant
State of Attorney-in-Fact
the Attorney-in-Fact the legal authority to act on my behalf for any power legal
under law in regard to my financial decisions under the State of
.
State
VII. SUCCESSOR ATTORNEY-IN-FACT (Optional) – If the Attorney-in-Fact named
above cannot or is unwilling to serve, then I appoint
,
Name of Successor Attorney-in-Fact
residing at
Street Address of Successor Attorney-in-Fact
City of
, State of
City of Successor Attorney-in-Fact
grant
State of Successor Attorney-in-Fact
the Attorney-in-Fact the legal authority to act on my behalf for any power legal
under law in regard to my financial decisions under the State of
.
State
VIII. TERMS & CONDITIONS – Upon authorization by all parties, the Attorney-inFact accepts their designation to act in the Principal’s best interests for all
financial decisions legal under law.
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.
Note: If you initial Item A or Item B, which follow, a notarized signature will be
required on behalf of the Principal.
INITIAL
_______ (A) Real property transactions. To lease, sell, mortgage, purchase,
exchange, and acquire, and to agree, bargain, and contract for the lease, sale,
purchase, exchange, and acquisition of, and to accept, take, receive, and
possess any interest in real property whatsoever, on such terms and conditions,
and under such covenants, as my Agent shall deem proper; and to maintain,
repair, tear down, alter, rebuild, improve manage, insure, move, rent, lease,
sell, convey, subject to liens, mortgages, and security deeds, and in any way or
manner deal with all or any part of any interest in real property whatsoever,
including specifically, but without limitation, real property lying and being
situated in the State of California, under such terms and conditions, and under
such covenants, as my Agent shall deem proper and may for all deferred
payments accept purchase money notes payable to me and secured by
mortgages or deeds to secure debt, and may from time to time collect and
cancel any of said notes, mortgages, security interests, or deeds to secure
debt.
_______ (B) Tangible personal property transactions. To lease, sell, mortgage,
purchase, exchange, and acquire, and to agree, bargain, and contract for the
lease, sale, purchase, exchange, and acquisition of, and to accept, take,
receive, and possess any personal property whatsoever, tangible or intangible,
or interest thereto, on such terms and conditions, and under such covenants,
as my Agent shall deem proper; and to maintain, repair, improve, manage,
insure, rent, lease, sell, convey, subject to liens or mortgages, or to take any
other security interests in said property which are recognized under the
Uniform Commercial Code as adopted at that time under the laws of the State
of California or any applicable state, or otherwise hypothecate (pledge), and in
any way or manner deal with all or any part of any real or personal property
whatsoever, tangible or intangible, or any interest therein, that I own at the
time of execution or may thereafter acquire, under such terms and conditions,
and under such covenants, as my Agent shall deem proper.
_______ (C) Stock and bond transactions. To purchase, sell, exchange,
surrender, assign, redeem, vote at any meeting, or otherwise transfer any and
all shares of stock, bonds, or other securities in any business, association,
corporation, partnership, or other legal entity, whether private or public, now
or hereafter belonging to me.
_______ (D) Commodity and option transactions. To organize or continue and
conduct any business which term includes, without limitation, any farming,
manufacturing, service, mining, retailing or other type of business operation in
any form, whether as a proprietorship, joint venture, partnership, corporation,
trust or other legal entity; operate, buy, sell, expand, contract, terminate or
liquidate any business; direct, control, supervise, manage or participate in the
operation of any business and engage, compensate and discharge business
managers, employees, agents, attorneys, accountants and consultants; and, in
general, exercise all powers with respect to business interests and operations
which the principal could if present and under no disability.
_______ (E) Banking and other financial institution transactions. To make,
receive, sign, endorse, execute, acknowledge, deliver and possess checks,
drafts, bills of exchange, letters of credit, notes, stock certificates, withdrawal
receipts and deposit instruments relating to accounts or deposits in, or
certificates of deposit of banks, savings and loans, credit unions, or other
institutions or associations. To pay all sums of money, at any time or times,
that may hereafter be owing by me upon any account, bill of exchange, check,
draft, purchase, contract, note, or trade acceptance made, executed,
endorsed, accepted, and delivered by me or for me in my name, by my Agent.
To borrow from time to time such sums of money as my Agent may deem
proper and execute promissory notes, security deeds or agreements, financing
statements, or other security instruments in such form as the lender may
request and renew said notes and security instruments from time to time in
whole or in part. To have free access at any time or times to any safe deposit
box or vault to which I might have access.
_______ (F) Business operating transactions. To conduct, engage in, and
otherwise transact the affairs of any and all lawful business ventures of
whatever nature or kind that I may now or hereafter be involved in.
_______ (G) Insurance and annuity transactions. To exercise or perform any
act, power, duty, right, or obligation, in regard to any contract of life,
accident, health, disability, liability, or other type of insurance or any
combination of insurance; and to procure new or additional contracts of
insurance for me and to designate the beneficiary of same; provided, however,
that my Agent cannot designate himself or herself as beneficiary of any such
insurance contracts.
_______ (H) Estate, trust, and other beneficiary transactions. To accept,
receipt for, exercise, release, reject, renounce, assign, disclaim, demand, sue
for, claim and recover any legacy, bequest, devise, gift or other property
interest or payment due or payable to or for the principal; assert any interest
in and exercise any power over any trust, estate or property subject to
fiduciary control; establish a revocable trust solely for the benefit of the
principal that terminates at the death of the principal and is then distributable
to the legal representative of the estate of the principal; and, in general,
exercise all powers with respect to estates and trusts which the principal could
exercise if present and under no disability; provided, however, that the Agent
may not make or change a will and may not revoke or amend a trust revocable
or amendable by the principal or require the trustee of any trust for the
benefit of the principal to pay income or principal to the Agent unless specific
authority to that end is given.
_______ (I) Claims and litigation. To commence, prosecute, discontinue, or
defend all actions or other legal proceedings touching my property, real or
personal, or any part thereof, or touching any matter in which I or my
property, real or personal, may be in any way concerned. To defend, settle,
adjust, make allowances, compound, submit to arbitration, and compromise all
accounts, reckonings, claims, and demands whatsoever that now are, or
hereafter shall be, pending between me and any person, firm, corporation, or
other legal entity, in such manner and in all respects as my Agent shall deem
proper.
_______ (J) Personal and family maintenance. To hire accountants, attorneys
at law, consultants, clerks, physicians, nurses, agents, servants, workmen, and
others and to remove them, and to appoint others in their place, and to pay
and allow the persons so employed such salaries, wages, or other
remunerations, as my Agent shall deem proper.
_______ (K) Benefits from Social Security, Medicare, Medicaid, or other
governmental programs, or military service. To prepare, sign and file any claim
or application for Social Security, unemployment or military service benefits;
sue for, settle or abandon any claims to any benefit or assistance under any
federal, state, local or foreign statute or regulation; control, deposit to any
account, collect, receipt for, and take title to and hold all benefits under any
Social Security, unemployment, military service or other state, federal, local or
foreign statute or regulation; and, in general, exercise all powers with respect
to Social Security, unemployment, military service, and governmental benefits,
including but not limited to Medicare and Medicaid, which the principal could
exercise if present and under no disability.
_______ (L) Retirement plan transactions. To contribute to, withdraw from and
deposit funds in any type of retirement plan (which term includes, without
limitation, any tax qualified or nonqualified pension, profit sharing, stock
bonus, employee savings and other retirement plan, individual retirement
account, deferred compensation plan and any other type of employeebenefit
plan); select and change payment options for the principal under any
retirement plan; make rollover contributions from any retirement plan to other
retirement plans or individual retirement accounts; exercise all investment
powers available under any type of self-directed retirement plan; and, in
general, exercise all powers with respect to retirement plans and retirement
plan account balances which the principal could if present and under no
disability.
_______ (M) Tax matters. To prepare, to make elections, to execute and to file
all tax, social security, unemployment insurance, and informational returns
required by the laws of the United States, or of any state or subdivision
thereof, or of any foreign government; to prepare, to execute, and to file all
other papers and instruments which the Agent shall think to be desirable or
necessary for safeguarding of me against excess or illegal taxation or against
penalties imposed for claimed violation of any law or other governmental
regulation; and to pay, to compromise, or to contest or to apply for refunds in
connection with any taxes or assessments for which I am or may be liable.
IX. THIRD PARTIES – I, the Principal, agree that any third party receiving a
copy via: physical copy, email, or fax that I, the Principal, will indemnify and
hold harmless any and all claims that may be put forth in reference to this
Durable Power of Attorney Form.
X. COMPENSATION – The Attorney-in-Fact agrees not to be compensated for
acting in the presence of the Principal. The Attorney-in-Fact may be, but not
entitled to, reimbursement for all: food, travel, and lodging expenses for
acting in the presence of the Principal.
XI. DISCLOSURE - I intend for my attorney-in-fact under this Power of Attorney
to be treated, as I would be with respect to my rights regarding the use and
disclosure of my individually identifiable health information or other medical
records. This release authority applies to any information governed by the
Health Insurance Portability and Accountability Act of 1996 (aka HIPAA), 42 USC
1320d and 45 CFR 160-164
XII. PRINCIPAL’S SIGNATURE - I,
, the Principal,
Printed Name of Principal
sign my name to this power of attorney this
day of
Day
and, being first duly sworn, do declare to the
Month
undersigned authority that I sign and execute this instrument as my power of
attorney and that I sign it willingly, or willingly direct another to sign for me,
that I execute it as my free and voluntary act for the purposes expressed in the
power of attorney and that I am eighteen years of age or older, of sound mind
and under no constraint or undue influence.
Signature of Principal
XIII. ATTORNEY-IN-FACT’S SIGNATURE- I,
Name of Attorney-in-Fact
have read the attached power of attorney and am the person identified as the
attorney-in-fact for the principal. I hereby acknowledge and accept my
appointment as Attorney-in-Fact and that when I act as agent I shall exercise
the powers for the benefit of the principal; I shall keep the assets of the
principal separate from my assets; I shall exercise reasonable caution and
prudence; and I shall keep a full and accurate record of all actions, receipts
and disbursements on behalf of the principal.
Signature of Attorney-in-Fact
Date
XIV. SUCCESSOR ATTORNEY-IN-FACT’S SIGNATURE (Optional) I,
have read the attached power of
Name of successor Attorney-in-Fact
attorney and am the person identified as the successor attorney-in-fact for the
principal. I hereby acknowledge that I accept my appointment as Successor
Attorney-in-Fact and that, in the absence of a specific provision to the contrary
in the power of attorney, when I act as agent I shall exercise the powers for
the benefit of the principal; I shall keep the assets of the principal separate
from my assets; I shall exercise reasonable caution and prudence; and I shall
keep a full and accurate record of all actions, receipts, and disbursements on
behalf of the principal.
Signature of Successor Attorney-in-Fact
Date
Notary Acknowledgement (Must be completed by Notary)
State of
County of
Sworn and acknowledged before me by
Principal, and subscribed and sworn to before me by
witness, this
day of
Subscribed,
, the
,
.
Notary Signature
Notary Public
In and for the County of
State of
My commission expires:
Seal
Acknowledgement and Acceptance of Appointment as Attorney-in-Fact
I,
have read the attached power of attorney
Name of Attorney-in-Fact
and am the person identified as the attorney-in-fact for the principal. I hereby
acknowledge that accept my appointment as Attorney-in-Fact and that when I
act as agent I shall exercise the powers for the benefit of the principal; I shall
keep the assets of the principal separate from my assets; I shall exercise
reasonable caution and prudence; and I shall keep a full and accurate of all
actions, receipts and disbursements on behalf of the principal.
Signature of Attorney-in-Fact
Date
Acceptance of Appointment as successor Attorney-in-Fact
I,
have read the attached power of
Name of successor Attorney-in-Fact
attorney and am the person identified as the successor attorney-in-fact for the
principal. I hereby acknowledge that I accept my appointment as Successor
Attorney-in-Fact and that, in the absence of a specific provision to the contrary
in the power of attorney, when I act as agent I shall exercise the powers for
the benefit of the principal; I shall keep the assets of the principal separate
from my assets; I shall exercise reasonable caution and prudence; and I shall
keep a full and accurate record of all actions, receipts, and disbursements on
behalf of the principal.
Signature of Successor Attorney-in-Fact
Date
Witness Attestation
I,
, the first witness, and I
Printed Name of First Witness
Printed Name of Second Witness
the second witness, sign my name to the foregoing power of attorney being
first duly sworn and do not declare to the undersigned authority that the
principal signs and executed this instrument as him or her, and that I, in the
presence and hearing of the principal, sign this power of attorney as witness to
the principal’s signing and that to the best of my knowledge the principal is
eighteen years of age or older, of sound mind and under no constraint or undue
influence.
Signature of First Witness
Signature of Second Witness