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DURABLE POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that I ____________________, of
____________________ do hereby make, constitute and appoint
____________________ of ____________________ my true and lawful attorney for me
and in my name, place and stead, and in my behalf, and for my use and benefit:
1. To exercise or perform any act, power, duty, right or obligation whatsoever that I now
have, or may hereafter acquire the legal right, power, or capacity to exercise or perform,
in connection with, arising from, or relating to any person, item, transaction, thing,
business, property, real or personal, tangible or intangible, or matter whatsoever.
2. To request, ask, demand, sue for, recover, collect, receive, and hold, possess and
invest all sums of money, debts, commercial paper, checks, drafts, accounts, deposits,
bequests, devises, notes, interests, bonds, dividends, certificates of deposit, any and all
documents of title, causes in action, and demands whatsoever, whether agreed to or
disputed, as now are, or shall hereafter become, owned by, or due, owing payable, or
belonging to, me or in which I have or may hereafter acquire any interest, to have, or use;
and take all lawful means and equitable and legal remedies, procedures, and writs in my
name for the collection and recovery thereof, and to adjust, sell, compromise, and agree
for the same; and to make, execute, and deliver for me, on my behalf, and in my name,
all endorsements, releases, receipts, or other proper discharges for the same as if done by
me personally.
3. To maintain, repair, improve, manage, insure, rent, lease, grant, bargain, sell,
exchange, pledge and contract for all of the foregoing, 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 now own or may hereafter acquire, in my behalf, and in my
name; and to effect any or all of the above-described transactions to any entities on such
terms and at prices my attorney-in-fact may deem proper, and in my name to make,
execute, acknowledge and deliver any deed of conveyance or other instrument, necessary
to effect such transactions; and to ask for, demand, sue for, collect, recover and receive
all monies which may become due and owing to me by reason of such transaction.
4. To conduct, engage in, and transact any and all lawful business of whatever nature or
kind for me, on my behalf and in my name.
5. To receive, deposit, hold, invest or cash all payments which I receive from Social
Security, Medicare or any other government program or agency, annuities, pension and
retirement benefits, insurance benefits and proceeds and to request, ask, demand, sue for
and recover same.
6. To make, receive, sign, endorse, execute, acknowledge, deliver, and possess such
applications, contracts, agreements, options, covenants, conveyances, deeds, trust deeds,
security agreements, bills of sale, leases, mortgages, assignments, insurance policies, bills
of lading, warehouse receipts, documents of title, bonds, debentures, checks, drafts, bills
of exchange, letters of credit, notes, stock certificates, proxies, warrants, commercial
paper, receipts, withdrawal receipts and deposit instruments relating to accounts or
deposits in, certificates of deposit of, or investments with or through banks, savings and
loan brokers, mutual fund companies or other institutions or associations, proofs of loss,
evidences of debts, releases, and satisfaction of mortgages, lien, judgments, security
agreements and other debts and obligations and such other instruments in writing of
whatever kind and nature as may be necessary or proper in the exercise of the rights and
powers herein granted.
7. To enter any safe deposit box, vault or other storage area leased by me alone or in
conjunction with any other person, to sign such documents as may be necessary to gain
access to same, and to examine, remove and keep the contents of same fully as I could if
I were present.
8. To prepare, or cause to be prepared, federal, state and local tax returns and Internal
Revenue Service, state and local powers of attorney; to execute and file federal, state and
local tax returns on my behalf and in my name; to respond to notices and audit inquiries
and to settle tax disputes.
9. To deal with and elect options under retirement plans including but not limited to
annuities, pension plans, profit sharing plans, individual retirement accounts, rollovers,
transfer and voluntary contributions of same; to apply for and maintain life insurance; to
complete charitable contributions; to make statutory elections and disclaimers; and to
settle, pursue, or appeal litigation on my behalf and in my name.
10. To make, execute, deliver and complete gifts of my property, whether real or
personal, tangible or intangible, and without regard to whether such gifts are a part of
estate planning or otherwise, and regardless of whether such gifts are a part of a pattern
begun by me.
11. I grant to said attorney full power and authority to do, take, and perform, all and
every act and thing whatsoever requisite, proper, or necessary to be done, in the exercise
of any of the rights and powers herein granted, as fully for all intents and purposes as I
might or could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that said attorney, or his substitute or substitutes, shall
lawfully do or cause to be done by virtue of this power of attorney and the rights and
powers herein granted.
12. No person shall be required to inquire as to the circumstances of the issuance or use
of this instrument or as to the disposition of any proceeds paid to my attorney based on
this instrument.
____________________
As used herein, "disability" or "incapacity" shall mean that my ability to receive and
evaluate information effectively or to communicate decisions, or both, is impaired to
such an extent that I lack the capacity to manage my financial resources as determined by
the certification of one licensed physician, and shall include by inability to take actions
due to involuntary detention or disappearance, as determined by affidavit of one party
with knowledge regarding the same. I hereby waive any physician-client privilege for
this limited purpose and authorize the disclosure or such certification by the physician to
my agent for use by that person as necessary hereunder.
____________________
If this Durable Power of Attorney is terminated by operation of law, any person acting in
reliance upon it without notice of such termination shall be held harmless. The
enumeration of specific terms, rights, acts or powers is not intended to limit the
definition or scope of powers granted herein.
IN WITNESS WHEREOF, ____________________ has executed this Durable Power of
Attorney on ____________ at ____________________.
_____________________
___________
____________________
____________________
State of __________________________ )
) ss
County of ________________________ )
On this ______________, before me personally appeared ____________________, to
me known to be the person described in and who executed the foregoing instrument and
acknowledged to me that ____________________ executed the same as
____________________ free act and deed.
_________________________________
Notary Public
