Maryland Statutory Form Limited Power of Attorney

MARYLAND STATUTORY FORM
LIMITED POWER OF ATTORNEY
PLEASE READ CAREFULLY
This power of attorney authorizes another person (your agent) to make decisions concerning
your property for you (the principal). You need not give to your agent all of the authorities listed
below and may give the agent only those limited powers that you specifically indicate. This
gives your agent the right to make limited decisions for you. You should very carefully weigh
your decision as to what powers you give your agent. Your agent will be able to make decisions
and act with respect to your property (including your money) whether or not you are able to act
for yourself.
If you choose to make a grant of limited authority, you should check the boxes that identify the
specific authorization you choose to give your agent.
This power of attorney does not authorize the agent to make health care decisions for you.
You should select someone you trust to serve as your agent. Unless you specify otherwise,
generally the agent's authority will continue until you die or revoke the power of attorney or the
agent resigns or is unable to act for you.
Your agent is not entitled to compensation unless you indicate otherwise in the Special
Instructions of this power of attorney. If you indicate that your agent is to receive compensation,
your agent is entitled to reasonable compensation or compensation as specified in the Special
Instructions.
This form provides for designation of one agent. If you wish to name more than one agent you
may name a coagent in the Special Instructions. Coagents are required to act together
unanimously unless you specify otherwise in the Special Instructions.
If your agent is unavailable or unwilling to act for you, your power of attorney will end unless
you have named a successor agent. You may also name a second successor agent.
This power of attorney becomes effective immediately unless you state otherwise in the Special
Instructions.
If you have questions about the power of attorney or the authority you are granting to your agent,
you should seek legal advice before signing this form.
DESIGNATION OF AGENT
This section of the form provides for designation of one agent.
If you wish to name coagents, skip this section and use the next section ("Designation of
Coagents").
I,
,
(Name of Principal)
name the following person as my agent:
Name of Agent:
Agent's Address:
Agent's Telephone Number:
DESIGNATION OF COAGENTS (OPTIONAL)
This section of the form provides for designation of two or more coagents. Coagents are
required to act together unanimously unless otherwise provided in this form.
I,
,
(Name of Principal)
name the following persons as coagents:
Name of Coagent:
Coagent's Address:
Coagent's Telephone Number:
Name of Coagent:
Coagent's Address:
Coagent's Telephone Number:
Special Instructions Regarding Coagents:
DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)
If my agent is unable or unwilling to act for me, I name as my successor agent:
Name of Successor Agent:
Successor Agent's Address:
Successor Agent's Telephone Number:
If my successor agent is unable or unwilling to act for me, I name as my second successor agent:
Name of Second Successor Agent:
Second Successor Agent's Address:
Second Successor Agent's Telephone Number:
GRANT OF GENERAL AUTHORITY
I ("the principal") grant my agent and any successor agent, with respect to each subject that I
choose below, the authority to do all acts that I could do to:
(1) Demand, receive, and obtain by litigation or otherwise, money or another thing of
value to which the principal is, may become, or claims to be entitled, and conserve, invest,
disburse, or use anything so received or obtained for the purposes intended;
(2) Contract with another person, on terms agreeable to the agent, to accomplish a
purpose of a transaction and perform, rescind, cancel, terminate, reform, restate, release, or
modify the contract or another contract made by or on behalf of the principal;
(3) Execute, acknowledge, seal, deliver, file, or record any instrument or communication
the agent considers desirable to accomplish a purpose of a transaction, including creating a
schedule contemporaneously or at a later time listing some or all of the principal's property and
attaching the schedule to this power of attorney;
(4) Initiate, participate in, submit to alternative dispute resolution, settle, oppose, or
propose or accept a compromise with respect to a claim existing in favor of or against the
principal or intervene in litigation relating to the claim;
(5) Seek on the principal's behalf the assistance of a court or other governmental agency
to carry out an act authorized in this power of attorney;
(6) Engage, compensate, and discharge an attorney, accountant, discretionary investment
manager, expert witness, or other advisor;
(7) Prepare, execute, and file a record, report, or other document to safeguard or promote
the principal's interest under a statute or regulation;
(8) Communicate with representatives or employees of a government or governmental
subdivision, agency, or instrumentality, on behalf of the principal;
(9) Access communications intended for, and communicate on behalf of the principal,
whether by mail, electronic transmission, telephone, or other means; and
(10) Do lawful acts with respect to the subject and all property related to the subject.
(INITIAL each authority in any subject you want to include in the agent's general authority.
Cross through each authority in any subject that you want to exclude. If you wish to grant
general authority over an entire subject, you may initial "All of the above" instead of initialing
each authority.)
SUBJECTS AND AUTHORITY
A. Real Property – With respect to this category, I authorize my agent to:
(___) Demand, buy, lease, receive, accept as a gift or as security for an extension of credit, or
otherwise acquire or reject an interest in real property or a right incident to real property
(___) Sell, exchange, convey with or without covenants, representations, or warranties,
quitclaim, release, surrender, retain title for security, encumber, partition, consent to
partitioning, subject to an easement or covenant, subdivide, apply for zoning or other
governmental permits, plat or consent to platting, develop, grant an option concerning,
lease, sublease, contribute to an entity in exchange for an interest in that entity, or
otherwise grant or dispose of an interest in real property or a right incident to real
property
(___) Pledge or mortgage an interest in real property or right incident to real property as
security to borrow money or pay, renew, or extend the time of payment of a debt of the
principal or a debt guaranteed by the principal, including a reverse mortgage
(___) Release, assign, satisfy, or enforce by litigation or otherwise a mortgage, deed of trust,
conditional sale contract, encumbrance, lien, or other claim to real property that exists or
is asserted
(___) Manage or conserve an interest in real property or a right incident to real property owned
or claimed to be owned by the principal, including:
(1)
Insuring against liability or casualty or other loss;
(2) Obtaining or regaining possession of or protecting the interest or right by
litigation or otherwise;
(3) Paying, assessing, compromising, or contesting taxes or assessments or
applying for and receiving refunds in connection with them; and
(4) Purchasing supplies, hiring assistance or labor, and making repairs or
alterations to the real property
(___) Use, develop, alter, replace, remove, erect, or install structures or other improvements on
real property in or incident to which the principal has, or claims to have, an interest or
right
(___) Participate in a reorganization with respect to real property or an entity that owns an
interest in or a right incident to real property and receive, hold, and act with respect to
stocks and bonds or other property received in a plan of reorganization, including:
(1)
Selling or otherwise disposing of the stocks and bonds or other property;
(2) Exercising or selling an option, a right of conversion, or a similar right with
respect to the stocks and bonds or other property; and
(3)
Exercising voting rights in person or by proxy
(___) Change the form of title of an interest in or a right incident to real property
(___) Dedicate to public use, with or without consideration, easements or other real property in
which the principal has, or claims to have, an interest
(___) All of the above
B. Tangible Personal Property – With respect to this subject, I authorize my agent to:
(___) Demand, buy, receive, accept as a gift or as security for an extension of credit, or
otherwise acquire or reject ownership or possession of tangible personal property or an
interest in tangible personal property
(___) Sell, exchange, convey with or without covenants, representations, or warranties,
quitclaim, release, surrender, create a security interest in, grant options concerning, lease,
sublease, or otherwise dispose of tangible personal property or an interest in tangible
personal property
(___) Grant a security interest in tangible personal property or an interest in tangible personal
property as security to borrow money or pay, renew, or extend the time of payment of a
debt of the principal or a debt guaranteed by the principal
(___) Release, assign, satisfy, or enforce by litigation or otherwise, a security interest, lien, or
other claim on behalf of the principal, with respect to tangible personal property or an
interest in tangible personal property
(___) Manage or conserve tangible personal property or an interest in tangible personal
property on behalf of the principal, including:
(1)
Insuring against liability or casualty or other loss;
(2) Obtaining or regaining possession of or protecting the property or interest,
by litigation or otherwise;
(3) Paying, assessing, compromising, or contesting taxes or assessments or
applying for and receiving refunds in connection with taxes or assessments;
(4)
Moving the property from place to place;
(5)
Storing the property for hire or on a gratuitous bailment; and
(6)
Using and making repairs, alterations, or improvements to the property
(___) Change the form of title of an interest in tangible personal property
(___) All of the above
C. Stocks and Bonds – With respect to this subject, I authorize my agent to:
(___) Buy, sell, and exchange stocks and bonds
(___) Establish, continue, modify, or terminate an account with respect to stocks and bonds
(___) Pledge stocks and bonds as security to borrow, pay, renew, or extend the time of payment
of a debt of the principal
(___) Receive certificates and other evidences of ownership with respect to stocks and bonds
(___) Exercise voting rights with respect to stocks and bonds in person or by proxy, enter into
voting trusts, and consent to limitations on the right to vote
(___) All of the above
D. Commodities – With respect to this subject, I authorize my agent to:
(___) Buy, sell, exchange, assign, settle, and exercise commodity futures contracts and call or
put options on stocks or stock indexes traded on a regulated option exchange
(___) Establish, continue, modify, and terminate option accounts
(___) All of the above
E. Banks and Other Financial Institutions – With respect to this subject, I authorize
my agent to:
(___) Continue, modify, transact all business in connection with, and terminate an account or
other banking arrangement made by or on behalf of the principal
(___) Establish, modify, transact all business in connection with, and terminate an account or
other banking arrangement with a bank, trust company, savings and loan association,
credit union, thrift company, brokerage firm, or other financial institution selected by the
agent
(___) Contract for services available from a financial institution, including renting a safe
deposit box or space in a vault
(___) Deposit by check, money order, electronic funds transfer, or otherwise with, or leave in
the custody of, a financial institution money or property of the principal.
(___) Withdraw, by check, money order, electronic funds transfer, or otherwise, money or
property of the principal deposited with or left in the custody of a financial institution
(___) Receive statements of account, vouchers, notices, and similar documents from a financial
institution and act with respect to them
(___) Enter a safe deposit box or vault and withdraw or add to the contents
(___) Borrow money and pledge as security personal property of the principal necessary to
borrow money or pay, renew, or extend the time of payment of a debt of the principal or a
debt guaranteed by the principal
(___) Make, assign, draw, endorse, discount, guarantee, and negotiate promissory notes,
checks, drafts, and other negotiable or nonnegotiable paper of the principal or payable to
the principal or the principal's order, transfer money, receive the cash or other proceeds of
those transactions, and accept a draft drawn by a person on the principal and pay the draft
when due
(___) Receive for the principal and act on a sight draft, warehouse receipt, other document of
title whether tangible or electronic, or other negotiable or nonnegotiable instrument
(___) Apply for, receive, and use letters of credit, credit cards and debit cards, electronic
transaction authorizations, and traveler's checks from a financial institution and give an
indemnity or other agreement in connection with letters of credit
(___) Consent to an extension of the time of payment with respect to commercial paper or a
financial transaction with a financial institution
(___) All of the above
F. Operation of an Entity or a Business – With respect to this subject, I authorize my
agent to:
(___) Operate, buy, sell, enlarge, reduce, or terminate an ownership interest
(___) Perform a duty or discharge a liability and exercise in person or by proxy a right, power,
privilege, or an option that the principal has, may have, or claims to have
(___) Enforce the terms of an ownership agreement
(___) Initiate, participate in, submit to alternative dispute resolution, settle, oppose, or propose
or accept a compromise with respect to litigation to which the principal is a party because
of an ownership interest
(___) Exercise in person or by proxy, or enforce by litigation or otherwise, a right, power,
privilege, or an option the principal has or claims to have as the holder of stocks and
bonds
(___) Initiate, participate in, submit to alternative dispute resolution, settle, oppose, or propose
or accept a compromise with respect to litigation to which the principal is a party
concerning stocks and bonds
(___) With respect to an entity or business owned solely by the principal:
(1) Continue, modify, renegotiate, extend, and terminate a contract made by or
on behalf of the principal with respect to the entity or business before execution of this
power of attorney;
(2)
Determine:
(i)
The location of the operation of the entity or business;
(ii)
The nature and extent of the business of the entity or business;
(iii) The methods of manufacturing, selling, merchandising, financing,
accounting, and advertising employed in the operation of the entity or business;
(iv) The amount and types of insurance carried by the entity or business;
and
(v) The mode of engaging, compensating, and dealing with the employees
and accountants, attorneys, or other advisors of the entity or business;
(3) Change the name or form of organization under which the entity or business
is operated and enter into an ownership agreement with other persons to take over all or
part of the operation of the entity or business; and
(4) Demand and receive money due or claimed by the principal or on the
principal's behalf in the operation of the entity or business and control and disburse the
money in the operation of the entity or business
(___) Put additional capital into an entity or a business in which the principal has an interest
(___) Join in a plan of reorganization, consolidation, conversion, domestication, or merger of
the entity or business
(___) Sell or liquidate all or part of an entity or business
(___) Establish the value of an entity or a business under a buyout agreement to which the
principal is a party
(___) Prepare, sign, file, and deliver reports, compilations of information, returns, or other
papers with respect to an entity or business and make related payments
(___) Pay, compromise, or contest taxes, assessments, fines, or penalties and perform other acts
to protect the principal from illegal or unnecessary taxation, assessments, fines, or
penalties, with respect to an entity or a business, including attempts to recover, as
permitted by law, money paid before or after the execution of this power of attorney
(___) All of the above
G. Insurance and Annuities – With respect to this subject, I authorize my agent to:
(___) Continue, pay the premium or make a contribution on, modify, exchange, rescind,
release, or terminate a contract procured by or on behalf of the principal that insures or
provides an annuity to either the principal or another person, whether or not the principal
is a beneficiary under the contract
(___) Procure new, different, and additional contracts of insurance and annuities for the
principal and the principal's spouse, children, and other dependents, and select the
amount, type of insurance or annuity, and mode of payment
(___) Pay the premium or make a contribution on, modify, exchange, rescind, release, or
terminate a contract of insurance or annuity procured by the agent
(___) Apply for and receive a loan secured by a contract of insurance or annuity
(___) Surrender and receive the cash surrender value on a contract of insurance or annuity
(___) Exercise an election
(___) Exercise investment powers available under a contract of insurance or annuity
(___) Change the manner of paying premiums on a contract of insurance or annuity
(___) Change or convert the type of insurance or annuity with respect to which the principal
has or claims to have authority described in this section
(___) Apply for and procure a benefit or assistance under a statute or regulation to guarantee or
pay premiums of a contract of insurance on the life of the principal
(___) Collect, sell, assign, hypothecate, borrow against, or pledge the interest of the principal in
a contract of insurance or annuity
(___) Select the form and timing of the payment of proceeds from a contract of insurance or
annuity
(___) Pay, from proceeds or otherwise, compromise or contest, and apply for refunds in
connection with a tax or assessment levied by a taxing authority with respect to a contract
of insurance or annuity or the proceeds or liability from the contract of insurance or
annuity accruing by reason of the tax or assessment
(___) All of the above
H. Estates, Trusts, and Other Beneficial Interests (including trusts, probate estates,
guardianships, conservatorships, escrows, or custodianships or funds from which the principal is,
may become, or claims to be entitled to a share or payment) – With respect to this subject, I
authorize my agent to:
(___) Accept, receive, receipt for, sell, assign, pledge, or exchange a share in or payment from
the fund described above
(___) Demand or obtain money or another thing of value to which the principal is, may
become, or claims to be entitled by reason of the fund described above, by litigation or
otherwise
(___) Exercise for the benefit of the principal a presently exercisable general power of
appointment held by the principal
(___) Initiate, participate in, submit to alternative dispute resolution, settle, oppose, or propose
or accept a compromise with respect to litigation to ascertain the meaning, validity, or
effect of a deed, will, declaration of trust, or other instrument or transaction affecting the
interest of the principal
(___) Initiate, participate in, submit to alternative dispute resolution, settle, oppose, or propose
or accept a compromise with respect to litigation to remove, substitute, or surcharge a
fiduciary
(___) Conserve, invest, disburse, or use anything received for an authorized purpose
(___) Transfer an interest of the principal in real property, stocks and bonds, accounts with
financial institutions or securities intermediaries, insurance, annuities, and other property
to the trustee of a revocable trust created by the principal as settlor
(___) Reject, renounce, disclaim, release, or consent to a reduction in or modification of a share
in or payment from the fund described above
(___) All of the above
I. Claims and Litigation – With respect to this subject, I authorize my agent to:
(___) Assert and maintain before a court or administrative agency a claim, claim for relief,
cause of action, counterclaim, offset, recoupment, or defense, including an action to
recover property or other thing of value, recover damages sustained by the principal,
eliminate or modify tax liability, or seek an injunction, specific performance, or other
relief
(___) Bring an action to determine adverse claims or intervene or otherwise participate in
litigation
(___) Seek an attachment, garnishment, order of arrest, or other preliminary, provisional, or
intermediate relief and use an available procedure to effect or satisfy a judgment, order,
or decree
(___) Make or accept a tender, offer of judgment, or admission of facts, submit a controversy
on an agreed statement of facts, consent to examination, and bind the principal in
litigation
(___) Submit to alternative dispute resolution, settle, and propose or accept a compromise
(___) Waive the issuance and service of process on the principal, accept service of process,
appear for the principal, designate persons on which process directed to the principal may
be served, execute and file or deliver stipulations on the principal's behalf, verify
pleadings, seek appellate review, procure and give surety and indemnity bonds, contract
and pay for the preparation and printing of records and briefs, receive, execute, and file or
deliver a consent, waiver, release, confession of judgment, satisfaction of judgment,
notice, agreement, or other instrument in connection with the prosecution, settlement, or
defense of a claim or litigation
(___) Act for the principal with respect to bankruptcy or insolvency, whether voluntary or
involuntary, concerning the principal or some other person, or with respect to a
reorganization, receivership, or application for the appointment of a receiver or trustee
that affects an interest of the principal in property or other thing of value
(___) Pay a judgment, award, or order against the principal or a settlement made in connection
with a claim or litigation
(___) Receive money or other thing of value paid in settlement of or as proceeds of a claim or
litigation
(___) All of the above
J. Personal and Family Maintenance – With respect to this subject, I authorize my
agent to:
(___) Perform the acts necessary to maintain the customary standard of living of the principal,
the principal's spouse, and the following individuals, whether living when this power of
attorney is executed or later born:
(1)
The principal's children;
(2)
Other individuals legally entitled to be supported by the principal; and
(3) The individuals whom the principal has customarily supported or indicated
the intent to support;
(___) Make periodic payments of child support and other family maintenance required by a
court or governmental agency or an agreement to which the principal is a party
(___) Provide living quarters for the individuals described above by:
(1)
Purchase, lease, or other contract; or
(2) Paying the operating costs, including interest, amortization payments,
repairs, improvements, and taxes, for premises owned by the principal or occupied by
those individuals
(___) Provide normal domestic help, usual vacations and travel expenses, and funds for shelter,
clothing, food, appropriate education, including postsecondary and vocational education,
and other current living costs for the individuals described above
(___) Pay expenses for necessary health care and custodial care on behalf of the individuals
described above
(___) Act as the principal's personal representative in accordance with the Health Insurance
Portability and Accountability Act, §§ 1171 through 1179 of the Social Security Act, 42
U.S.C. § 1320D, and applicable regulations in making decisions related to the past,
present, or future payment for the provision of health care consented to by the principal
or anyone authorized under the law of this state to consent to health care on behalf of the
principal
(___) Continue provisions made by the principal for automobiles or other means of
transportation, including registering, licensing, insuring, and replacing the means of
transportation, for the individuals described above
(___) Maintain credit and debit accounts for the convenience of the individuals described above
and open new accounts
(___) Continue payments incidental to the membership or affiliation of the principal in a
religious institution, club, society, order, or other organization or to continue
contributions to those organizations
(NOTE: Authority with respect to personal and family maintenance is neither dependent
on, nor limited by, authority that an agent may or may not have with respect to gifts under this
power of attorney.)
(___) All of the above
K. Benefits from Governmental Programs or Civil or Military Service (including
any benefit, program, or assistance provided under a statute or regulation including Social
Security, Medicare, and Medicaid) – With respect to this subject, I authorize my agent to:
(___) Execute vouchers in the name of the principal for allowances and reimbursements
payable by the United States or a foreign government or by a state or subdivision of a
state to the principal, including allowances and reimbursements for transportation of the
individuals described in "J. Personal and Family Maintenance" above, and for shipment
of the household effects of those individuals
(___) Take possession and order the removal and shipment of property of the principal from a
post, warehouse, depot, dock, or other place of storage or safekeeping, either
governmental or private, and execute and deliver a release, voucher, receipt, bill of
lading, shipping ticket, certificate, or other instrument for that purpose
(___) Enroll in, apply for, select, reject, change, amend, or discontinue, on the principal's
behalf, a benefit or program
(___) Prepare, file, and maintain a claim of the principal for a benefit or assistance, financial or
otherwise, to which the principal may be entitled under a statute or regulation
(___) Initiate, participate in, submit to alternative dispute resolution, settle, oppose, or propose
or accept a compromise with respect to litigation concerning a benefit or assistance the
principal may be entitled to receive under a statute or regulation
(___) Receive the financial proceeds of a claim described above and conserve, invest, disburse,
or use for a lawful purpose anything so received
(___) All of the above
L. Retirement Plans (including a plan or account created by an employer, the principal,
or another individual to provide retirement benefits or deferred compensation of which the
principal is a participant, beneficiary, or owner, including a plan or account under the following
sections of the Internal Revenue Code:
(1) An individual retirement account under Internal Revenue Code Section 408,
26 U.S.C. § 408;
(2) a Roth individual retirement account under Internal Revenue Code Section
408A, 26 U.S.C. § 408A;
(3) a deemed individual retirement account under Internal Revenue Code Section
408(q), 26 U.S.C. § 408(q);
(4) an annuity or mutual fund custodial account under Internal Revenue Code
Section 403(b), 26 U.S.C. § 403(b);
(5) a pension, profit–sharing, stock bonus, or other retirement plan qualified under
Internal Revenue Code Section 401(a), 26 U.S.C. § 401(a);
(6) a plan under Internal Revenue Code Section 457(b), 26 U.S.C. § 457(b); and
(7) a nonqualified deferred compensation plan under Internal Revenue Code
Section 409A, 26 U.S.C. § 409A) – With respect to this subject, I authorize my agent to:
(___) Select the form and timing of payments under a retirement plan and withdraw benefits
from a plan
(___) Make a rollover, including a direct trustee–to–trustee rollover, of benefits from one
retirement plan to another
(___) Establish a retirement plan in the principal's name
(___) Make contributions to a retirement plan
(___) Exercise investment powers available under a retirement plan
(___) Borrow from, sell assets to, or purchase assets from a retirement plan
(___) All of the above
M. Taxes – With respect to this subject, I authorize my agent to:
(___) Prepare, sign, and file federal, state, local, and foreign income, gift, payroll, property,
Federal Insurance Contributions Act, and other tax returns, claims for refunds, requests
for extension of time, petitions regarding tax matters, and other tax–related documents,
including receipts, offers, waivers, consents, including consents and agreements under
Internal Revenue Code Section 2032A, 26 U.S.C. § 2032A, closing agreements, and
other powers of attorney required by the Internal Revenue Service or other taxing
authority with respect to a tax year on which the statute of limitations has not run and the
following 25 tax years
(___) Pay taxes due, collect refunds, post bonds, receive confidential information, and contest
deficiencies determined by the Internal Revenue Service or other taxing authority
(___) Exercise elections available to the principal under federal, state, local, or foreign tax law
(___) Act for the principal in all tax matters for all periods before the Internal Revenue Service,
or other taxing authority
(___) All of the above
N. Gifts (including gifts to a trust, an account under the Uniform Transfers To Minors
Act, and a tuition savings account or prepaid tuition plan as defined under Internal Revenue
Code Section 529, 26 U.S.C. § 529) – With respect to this subject, I authorize my agent to:
(___) Make outright to, or for the benefit of, a person, a gift of part or all of the principal's
property, including by the exercise of a presently exercisable general power of
appointment held by the principal, in an amount for each donee not to exceed the annual
dollar limits of the federal gift tax exclusion under Internal Revenue Code Section
2503(b), 26 U.S.C. § 2503(b), without regard to whether the federal gift tax exclusion
applies to the gift, or if the principal's spouse agrees to consent to a split gift pursuant to
Internal Revenue Code Section 2513, 26 U.S.C. § 2513, in an amount for each donee not
to exceed twice the annual federal gift tax exclusion limit
(___) Consent, pursuant to Internal Revenue Code Section 2513, 26 U.S.C. § 2513, to the
splitting of a gift made by the principal's spouse in an amount for each donee not to
exceed the aggregate annual gift tax exclusions for both spouses
(NOTE: An agent may only make a gift of the principal's property as the agent
determines is consistent with the principal's objectives if actually known by the agent and, if
unknown, as the agent determines is consistent with the principal's best interest based on all
relevant factors, including:
(1)
the value and nature of the principal's property;
(2)
the principal's foreseeable obligations and need for maintenance;
(3)
minimization of taxes, including income, estate, inheritance, generation–
skipping transfer, and gift taxes;
(4)
eligibility for a benefit, a program, or assistance under a statute or
regulation; and
(5)
the principal's personal history of making or joining in making gifts.)
(___) All of the above
GRANT OF SPECIFIC AUTHORITY (OPTIONAL)
My agent MAY NOT do any of the following specific acts for me UNLESS I have INITIALED
the specific authority listed below:
(CAUTION: Granting any of the following will give your agent the authority to take actions that
could significantly reduce your property or change how your property is distributed at your
death. In addition, granting your agent the authority to make gifts to, or to designate as the
beneficiary of any retirement plan, the agent, the agent's spouse, or a dependent of the agent may
constitute a taxable gift by you and may make the property subject to that authority taxable as
part of the agent's estate. INITIAL ONLY the specific authority you WANT to give your agent.)
(___) Create an inter vivos trust, or amend, revoke, or terminate an existing inter vivos trust if
the trust expressly authorizes that action by the agent
(___) Make a gift, subject to any Special Instructions in this power of attorney
(___) Create or change rights of survivorship
(___) Create or change a beneficiary designation, subject to any special instructions in this
power of attorney; and, if I wish to authorize my agent to designate the agent, the agent's spouse,
or a dependent of the agent as a beneficiary, I will explicitly state this authority within the special
instructions of this power of attorney or in a separate power of attorney.
(___) Authorize another person to exercise the authority granted under this power of attorney
(___) Waive the principal's right to be a beneficiary of a joint and survivor annuity, including a
survivor benefit under a retirement plan
(___) Exercise fiduciary powers that the principal has authority to delegate
(___) Disclaim or refuse an interest in property, including a power of appointment
LIMITATION ON AGENT'S AUTHORITY
An agent that is not my ancestor, spouse, or descendant MAY NOT use my property to benefit
the agent or a person to whom the agent owes an obligation of support unless I have included
that authority in the Special Instructions.
SPECIAL INSTRUCTIONS (OPTIONAL)
You may give special instructions on the following lines:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
EFFECTIVE DATE
This power of attorney is effective immediately unless I have stated otherwise in the Special
Instructions.
TERMINATION DATE (OPTIONAL)
This power of attorney shall terminate on
, 20
(Use a specific calendar date)
.
NOMINATION OF GUARDIAN (OPTIONAL)
If it becomes necessary for a court to appoint a guardian of my property or guardian of my
person, I nominate the following person(s) for appointment:
Name of Nominee for guardian of my property:
Nominee's Address:
Nominee's Telephone Number:
Name of Nominee for guardian of my person:
Nominee's Address:
Nominee's Telephone Number:
SIGNATURE AND ACKNOWLEDGMENT
____________________________________________
Your Signature
__________________
Date
____________________________________________
Your Name Printed
____________________________________________
____________________________________________
Your Address
____________________________________________
Your Telephone Number
STATE OF MARYLAND
(COUNTY) OF ___________________________
This document was acknowledged before me on
__________________________,
(Date)
By ______________________________________ .
(Name of Principal)
____________________________________________
Signature of Notary
My commission expires: ________________________
(Seal, if any)
WITNESS ATTESTATION
The foregoing power of attorney was, on the date written above, published and declared by
______________________________________
(Name of Principal)
in our presence to be his/her power of attorney. We, in his/her presence and at his/her request,
and in the presence of each other, have attested to the same and have signed our names as
attesting witnesses.
____________________________________________
Witness #1 Signature
____________________________________________
Witness #1 Name Printed
____________________________________________
____________________________________________
Witness #1 Address
____________________________________________
Witness #1 Telephone Number
____________________________________________
Witness #2 Signature
____________________________________________
Witness #2 Name Printed
____________________________________________
____________________________________________
Witness #2 Address
____________________________________________
Witness #2 Telephone Number
This document prepared by:
IMPORTANT INFORMATION FOR AGENT
Agent's Duties
When you accept the authority granted under this power of attorney, a special legal relationship
is created between you and the principal. This relationship imposes on you legal duties that
continue until you resign or the power of attorney is terminated or revoked. You must:
(1)
Do what you know the principal reasonably expects you to do with the principal's
property or, if you do not know the principal's expectations, act in the principal's best
interest;
(2)
Act with care, competence, and diligence for the best interest of the principal;
(3)
Do nothing beyond the authority granted in this power of attorney; and
(4)
Disclose your identity as an agent whenever you act for the principal by writing or
printing the name of the principal and signing your own name as "agent" in the following
manner:
______________________________
(Principal's name)
by
________________________________
(Your signature) as agent
Unless the Special Instructions in this power of attorney state otherwise, you must also:
(1)
Act loyally for the principal's benefit;
(2)
Avoid conflicts that would impair your ability to act in the principal's best interest;
(3)
Keep a record of all receipts, disbursements, and transactions made on behalf of the
principal;
(4)
Cooperate with any person that has authority to make health care decisions for the
principal to do what you know the principal reasonably expects or, if you do not know
the principal's expectations, to act in the principal's best interest; and
(5)
Attempt to preserve the principal's estate plan if you know the plan and preserving the
plan is consistent with the principal's best interest.
Termination of Agent's Authority
You must stop acting on behalf of the principal if you learn of any event that terminates this
power of attorney or your authority under this power of attorney. Events that terminate a power
of attorney or your authority to act under a power of attorney include:
(1)
Death of the principal;
(2)
The principal's revocation of the power of attorney or your authority;
(3)
The occurrence of a termination event stated in the power of attorney;
(4)
The purpose of the power of attorney is fully accomplished; or
(5)
If you are married to the principal, a legal action is filed with a court to end your
marriage, or for your legal separation, unless the Special Instructions in this power of
attorney state that such an action will not terminate your authority.
Liability of Agent
The meaning of the authority granted to you is defined in the Maryland Power of Attorney Act,
Title 17 of the Estates and Trusts Article. If you violate the Maryland Power of Attorney Act,
Title 17 of the Estates and Trusts Article, or act outside the authority granted, you may be liable
for any damages caused by your violation.
If there is anything about this document or your duties that you do not understand, you should
seek legal advice.