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California ficial seal. Signature __________________________________ (Seal) -6- 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 ofnd 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_________________________ _______________________________________, 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 aornia County of ________________________ ) ) ss ) On __________ before me, ______________________________________________________ (here insert name and title of the officer), personally appeared ____: ___________________________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ Notary Acknowledgment State of Calif Witness Signature: ___________________________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ Witness Signaturetorney at any time by providing written notice to my Agent. Signed on ________________ (date), at _______________________ (city), California. ________________________________ Signature of Principal er, Agent will be liable for breach of fiduciary duty, failure to act in good faith and/or willful misconduct, while acting under the authority of this Power of Attorney. I may revoke this Power of Atfaith on the authority of this document, without notice of such termination, shall be held harmless. -5- Agent shall not be liable for losses resulting from judgment errors made in good faith. Howev party for any claims that arise against the third party because of reliance on this power of attorney. If this Durable Power of Attorney is terminated by operation of law, any person relying in good 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 thirdip with respect to any life insurance policies I may own on the life of my Agent; and/or (c) my assets to be subject to a general power of appointment by my Agent. Any third party who receives a copy is document. The powers granted to my Agent by this power-of-attorney are limited to the extent necessary to prevent (a) my income to be taxable to my Agent; (b) my Agent to have any rights or ownersh affected by any partial invalidity. No person needs to inquire as to the reasons for the use or issuance of this power-ofattorney or as to the disposition of any proceeds paid to my Agent based on thy part of this document is held to be invalid, illegal or unenforceable under applicable law, then the remaining unaffected parts of the document shall still remain in full force and effect and not beroadly as a General Power of Attorney. The listing of specific terms, rights, acts or powers are not intended to restrict or limit the definition or scope of powers granted herein in any manner. If an personal representative or fiduciary acting on my behalf, my Agent shall provide an accounting for all funds handled and all acts performed as my Agent. This Power of Attorney shall be construed as bng out any provision of this Power of Attorney. If desired, my Agent shall also be entitled to reasonable compensation for any services provided as my Agent If so requested by myself or any authorizedfectively, to communicate decisions, and/or to manage my financial resources and affairs properly. My Agent shall be entitled to reimbursement of all reasonable expenses incurred as a result of carryincapacity or lack of mental competence (except as provided by any applicable statute). As used herein, "disability" or "incapacity" shall mean a lack of capacity to receive and evaluate information efnstrument. The rights, powers, and authority of this document shall remain in full force and effect thereafter until my death. This Power of Attorney shall not terminate on my subsequent disability, iectly or indirectly to my Agent or my Agent's estate. -4- This Durable Power of Attorney and the rights, powers, and authority of my Agent shall become effective immediately upon execution of this ifrom any other person, estate, trust, or other entity, as may be appropriate. However, Agent may not disclaim assets, to which I would be entitled, if the result is that the disclaimed assets pass dirle trust created by me, if such trust exists at the time of such transfer. 17. To disclaim any interest (subject to other provisions of this document), which might be transferred or distributed to me ligations, including any obligations of support which my Agent may owe to others, excluding those whom I am legally obligated to support. 16. To transfer any of my assets to the trustee of any revocabwers of appointment I may hold in favor of my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, or (c) use any of my assets to discharge any of my Agent's legal obint, assign or designate any of my assets, interests or rights, directly or indirectly, to my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, (b) exercise any poalendar year, and this annual right shall be non-cumulative and shall lapse at the end of each calendar year. However, my Agent may not, unless specifically authorized by this document, (a) gift, appofers To Minors Act. Any gifts made shall be limited to gifts that qualify for the federal gift tax annual exclusion, shall not exceed in value the federal gift tax annual exclusion amount in any one cl gift tax returns and documents. Gifts to minors may be made to the minor directly or parent, guardian or close friend of the minor or pursuant to the Uniform Gifts to Minors Act or the Uniform Transal, tangible or intangible property, to such persons or organizations without regard to whether such gifts are a part of my estate planning or otherwise, and if necessary, to file any state and federay agency, including governmental agencies, relating to tax matters and to negotiate, compromise or settle any matter with such agency. 15. To make gifts and charitable contributions of my real, personor other governmental body, including, but not limited to, federal, state, local or other income and tax returns and necessary and/or related documents; to obtain or provide information to and from ant limited to, attorneys, accountants, investment professionals, brokers and real estate agents. 14. To prepare, or cause to be prepared, sign, and/or file any documents with any federal, state, local business that I currently own or have an interest in or may own or have an interest in, in the future. 13. To employ any professional and/or business assistance as may be appropriate, including but noontents. 11. To exercise any and all rights, including proxy rights, with respect to stocks, bonds, debentures, commodities, options or any other investments. -3- 12. To maintain and/or operate any sit box, vault or other storage area owned or leased by me alone or in conjunction with any other person, including access to their contents, and to examine, remove, keep or otherwise dispose of the c perform any act necessary to deposit, negotiate, sell or transfer any note, security, or draft of the United States of America, including U.S. Treasury Securities. 10. To have access to any safe depoinstruments, obtaining bank statements, passbooks, drafts, warrants, money orders, certificates, cashier checks, cash or vouchers payable to me by any person, firm, corporation or political entity; toany business with any banking or financial institution with respect to any of my accounts, including, but not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other to, checking accounts, savings accounts, certificates of deposit, investment accounts, brokerage accounts, retirement plan accounts, and other similar accounts with financial institutions; to conduct oint anyone, including my Agent, to act as my "Representative Payee" for the purpose of receiving Social Security benefits. 9. To open, maintain and/or close bank accounts, including, but not limited rform any other reasonable request by any government or its agencies in connection with governmental benefits (including but not limited to, medical, military and social security benefits), and to appsion, retirement benefits, retirement plans, insurance benefits and government program including, but not limited to, Social Security and Medicare; to prepare applications, provide information, and peher appropriate person and to make any elections and disclaimers under such policies. 8. To receive, deposit, hold, demand, deal with and/or sue to recover all payments I receive from any annuity, pen me by reason of such transaction. 7. To apply for, purchase, maintain and/or deal with insurance and annuity contracts, insurance policies, including life insurance upon my life or the life of any otwn or may own in the future; the right to remove tenants and to recover possession; and the right to ask for, demand, sue for, collect, recover and receive all monies which may become due and owing toible (now owned or acquired in the future by me) and to execute any necessary document, instrument or deed for such transactions. This includes the right to sell or encumber any homestead that I now oreinvest and in any other manner (on such terms and at prices my Agent may deem proper) deal with all, any part or any interest in any real or personal property or asset whatsoever, tangible or intangpayable, or belonging to, me or in which I have or may hereafter acquire any interest, to have, or use. 6. To maintain, manage, insure, lease, rent, sell, mortgage, improve, repair, exchange, invest, s, notes, interests, dividends, certificates of deposit, any and all documents of title and demands whatsoever, whether agreed to or disputed, now due or due -2- in the future, owned by, due, owing against any other person or entity. 5. To receive, hold, possess and/or invest any and all sums of money, accounts, debts, bonds, commercial papers, checks, drafts, causes of action, bequests, depositt, ask, demand, sue and take any and all legal steps necessary to recover and collect any amount or debt owed to me. 4. To adjust, compromise and settle any claim, against me or asserted on my behalf 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. 3. To requeshdrawal and deposit slips, certificates of deposit of, or investments with or through banks, savings and loan, brokers, mutual fund companies or other institutions, proofs of loss, evidences of debts,st deeds, security agreements, leases, mortgages, notes, insurance policies, receipts, title documents, checks, drafts, letters of credit, stock certificates, proxies, warrants, commercial papers, witcessary to enter into any such contract and/or agreement, including but not limited to applications, assignments, bills of sale or lading, bonds, contracts, covenants, conveyances, deeds, options, tru and all lawful business of whatever kind or nature, on my behalf and in my name. 2. To enter into binding contracts on my behalf and to sign, endorse and execute any written agreement and document ne or cause to be done by virtue of this power of attorney and the rights hereby granted. My Agent's powers and authority shall include, but not be limited to: 1. To conduct, engage in, and transact anyrsonal, tangible or intangible, or matter whatsoever as I could do if personally present. I hereby ratify and confirm all acts that my Agent, or my Agent's substitute or substitutes, shall lawfully dom any act, power, duty, legal right or obligation whatsoever that I now have or may later acquire in connection with or relating to any person, item, transaction, thing, business, property, real or pean address at: _____________________________________________________ my true and lawful attorney-in-fact for me and in my name, and in my behalf. My Agent shall have full power and authority to perfor_____________________ ("Principal") maintaining an address at _______________________________________________ do hereby make and appoint ________________________________________ ("Agent") maintaining then you should obtain the assistance of an attorney or other qualified person. -1- CALIFORNIA DURABLE POWER OF ATTORNEY Effective Immediately KNOW ALL PERSONS BY THESE PRESENTS: I, _______________nt the right to deal with property that you now have or might acquire in the future. The power of attorney is important to you. If you do not understand the power of attorney, or any provision of it, al property should be acknowledged before a notary public so that it may easily be recorded. You should read this power of attorney carefully. When effective, this power of attorney will give your agened 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 power of attorney that may affect reerminate this power of attorney at any time, so long as you are competent. This power of attorney must be dated and must be acknowledged before a notary public or signed by two witnesses. If it is sigey. You can amend or change this power of attorney only by executing a new power of attorney or by executing an amendment through the same formalities as an original. You have the right to revoke or tgent in this power of attorney will continue to exist even if you can no longer make your own decisions respecting the management of your property, unless you provide otherwise in this power of attorno exist for your entire lifetime, unless you state that the power of attorney will last for a shorter period of time or unless you otherwise terminate the power of attorney. The powers you give your al have the right to receive reasonable payment for services provided under this power of attorney unless you provide otherwise in this power of attorney. The powers you give your agent will continue tsell and convey your real and personal property, and to use your property as security if your agent borrows money on your behalf, unless you provide otherwise in this power of attorney. Your agent wiluld 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, A power of attorney is an important legal document. By signing the power of attorney, you are authorizing another person to act for you, the principal. Before you sign this power of attorney, you sho not state specific. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific instructions. -2- California Power of Attorney Warningsed, it is always a very good idea to do so. Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general information that isty of the Power of Attorney and will allow the Durable Power of Attorney to be recorded as a public record, if necessary. Although, some states don't require that a Durable Power of Attorney be witnes notarized, even if your state does not require it, especially if the Agent will be dealing with any real property. Notarization will make it more difficult for any third party to challenge the validithin the scope of the Power of Attorney document, will be legally binding upon the Grantor. The Grantor can revoke a Durable Power of Attorney at any time. A Durable Power of Attorney should always ben Attorney-In-Fact by a power of attorney. The Agent should be a competent adult. A Power of Attorney is a "powerful" instrument and should be granted with care. Any action undertaken by the Agent, wicapacitated. Note that the word "attorney" is not used here to mean "lawyer". The person acting as the Attorney-In-Fact for the Principal does not need to be a lawyer. Almost anyone can be appointed alf, even if the Principal later becomes incapacitated. This particular Form becomes effective immediately and remains in full force and effect even if the Principal (i.e. the Grantor) later becomes inrable Power of Attorney allows a natural "mentally" competent person (called the "Principal" or "Grantor") to authorize someone else (called the "Agent" or "Attorney-InFact") to act on his or her behath another party. The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com. -1- Information Durable Power of Attorney Effective Immediately A Dur legal advice. These forms should only be a starting point for you and should not be used without consulting with an attorney first. An Attorney should be consulted before negotiating any document wiranted by this document are very broad and sweeping, as the Agent has the power to handle business and legal matters on the Principal's behalf. These forms are not intended and are not a substitute forincipal should be careful in instructing the Agent (or attorney-in-fact) as to the tasks the Agent should complete. The Grantor should also be very careful in the selection of the Agent. The powers gs spouse or children, and the Notary should not be witnesses. The Principal should keep the original document, as well as a copy. The Agent should have access to the original document as needed. The Po witnesses. If two witnesses sign it, 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. The Agent, the Agent' allow the Durable Power of Attorney to be recorded as a public record, if necessary. In California, the power of attorney must be dated and must be acknowledged before a notary public or signed by twhe Durable Power of Attorney to be recorded as a public record, if necessary. The Principal (i.e. the person granting the power of Attorney) should sign the document before a Notary. Notarization will the Principal (i.e. the Grantor) becomes subsequently incapacitated. The Principal (i.e. the person granting the power of Attorney) should sign the document before a Notary. Notarization will allow ttion for Durable Power of Attorney Effective Immediately; (3) Durable Power of Attorney Effective Immediately This Durable Power of Attorney becomes effective immediately and remains effective even ifInstructions & Checklist California Durable Power of Attorney Effective Immediately This package contains (1) Instructions & Checklist for Durable Power of Attorney Effective Immediately; (2) Informa CaliforniaCalifornia nd official seal. Signature __________________________________ (Seal) -6- lf 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 aent 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 beha _____________________________ _______________________________________, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrumCalifornia County of ________________________ ) ) ss ) On __________ before me, ______________________________________________________ (here insert name and title of the officer), personally appearedature: ___________________________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ Notary Acknowledgment State of ipal Witness Signature: ___________________________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ Witness Sign of Attorney at any time by providing written notice to my Agent. Signed on ________________ (date), at _______________________ (city), California. ________________________________ Signature of Princ However, Agent will be liable for breach of fiduciary duty, failure to act in good faith and/or willful misconduct, while acting under the authority of this Power of Attorney. I may revoke this Power good faith on the authority of this document, without notice of such termination, shall be held harmless. -5- Agent shall not be liable for losses resulting from judgment errors made in good faith. third party for any claims that arise against the third party because of reliance on this power of attorney. If this Durable Power of Attorney is terminated by operation of law, any person relying in 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 thewnership with respect to any life insurance policies I may own on the life of my Agent; and/or (c) my assets to be subject to a general power of appointment by my Agent. Any third party who receives a on this document. The powers granted to my Agent by this power-of-attorney are limited to the extent necessary to prevent (a) my income to be taxable to my Agent; (b) my Agent to have any rights or onot be affected by any partial invalidity. No person needs to inquire as to the reasons for the use or issuance of this power-ofattorney or as to the disposition of any proceeds paid to my Agent based If any part of this document is held to be invalid, illegal or unenforceable under applicable law, then the remaining unaffected parts of the document shall still remain in full force and effect and d as broadly as a General Power of Attorney. The listing of specific terms, rights, acts or powers are not intended to restrict or limit the definition or scope of powers granted herein in any manner.orized personal representative or fiduciary acting on my behalf, my Agent shall provide an accounting for all funds handled and all acts performed as my Agent. This Power of Attorney shall be construecarrying out any provision of this Power of Attorney. If desired, my Agent shall also be entitled to reasonable compensation for any services provided as my Agent If so requested by myself or any authanage my financial resources and affairs properly, as certified in writing by a licensed medical doctor. My Agent shall be entitled to reimbursement of all reasonable expenses incurred as a result of as provided by any applicable statute. As used herein, "disability" or "incapacity" shall mean a lack of capacity to receive and evaluate information effectively, to communicate decisions, and/or to m this document shall remain in full force and effect thereafter until my death. This Power of Attorney shall not terminate on my subsequent disability, incapacity or lack of mental competence, except Attorney and all rights and powers therein shall become effective upon my subsequent disability or incapacity as certified in writing by a licensed medical doctor. The rights, powers, and authority ofver, Agent may not disclaim assets, to -4- which I would be entitled, if the result is that the disclaimed assets pass directly or indirectly to my Agent or my Agent's estate. This Durable Power of disclaim any interest (subject to other provisions of this document), which might be transferred or distributed to me from any other person, estate, trust, or other entity, as may be appropriate. Howeexcluding those whom I am legally obligated to support. 16. To transfer any of my assets to the trustee of any revocable trust created by me, if such trust exists at the time of such transfer. 17. To creditors, or the creditors of my Agent's estate, or (c) use any of my assets to discharge any of my Agent's legal obligations, including any obligations of support which my Agent may owe to others, ctly, to my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, (b) exercise any powers of appointment I may hold in favor of my Agent, my Agent's estate, my Agent's end of each calendar year. However, my Agent may not, unless specifically authorized by this document, (a) gift, appoint, assign or designate any of my assets, interests or rights, directly or indirefederal gift tax annual exclusion, shall not exceed in value the federal gift tax annual exclusion amount in any one calendar year, and this annual right shall be non-cumulative and shall lapse at they or parent, guardian or close friend of the minor or pursuant to the Uniform Gifts to Minors Act or the Uniform Transfers To Minors Act. Any gifts made shall be limited to gifts that qualify for the rd to whether such gifts are a part of my estate planning or otherwise, and if necessary, to file any state and federal gift tax returns and documents. Gifts to minors may be made to the minor directle, compromise or settle any matter with such agency. 15. To make gifts and charitable contributions of my real, personal, tangible or intangible property, to such persons or organizations without regar other income and tax returns and necessary and/or related documents; to obtain or provide information to and from any agency, including governmental agencies, relating to tax matters and to negotiatstate agents. 14. To prepare, or cause to be prepared, sign, and/or file any documents with any federal, state, local or other governmental body, including, but not limited to, federal, state, local ot in, in the future. 13. To employ any professional and/or business assistance as may be appropriate, including but not limited to, attorneys, accountants, investment professionals, brokers and real espect to stocks, bonds, debentures, commodities, options or any other investments. 12. To maintain and/or operate any business that I currently own or have an interest in or may own or have an interesnction with any other person, including access to their contents, and to examine, remove, keep or otherwise dispose of the contents. 11. To exercise any and all rights, including proxy rights, with reity, or draft of the United States of America, including U.S. Treasury Securities. -3- 10. To have access to any safe deposit box, vault or other storage area owned or leased by me alone or in conju certificates, cashier checks, cash or vouchers payable to me by any person, firm, corporation or political entity; to perform any act necessary to deposit, negotiate, sell or transfer any note, securccounts, including, but not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other instruments, obtaining bank statements, passbooks, drafts, warrants, money orders,nts, brokerage accounts, retirement plan accounts, and other similar accounts with financial institutions; to conduct any business with any banking or financial institution with respect to any of my ase of receiving Social Security benefits. 9. To open, maintain and/or close bank accounts, including, but not limited to, checking accounts, savings accounts, certificates of deposit, investment accou with governmental benefits (including but not limited to, medical, military and social security benefits), and to appoint anyone, including my Agent, to act as my "Representative Payee" for the purpogram including, but not limited to, Social Security and Medicare; to prepare applications, provide information, and perform any other reasonable request by any government or its agencies in connectiones. 8. To receive, deposit, hold, demand, deal with and/or sue to recover all payments I receive from any annuity, pension, retirement benefits, retirement plans, insurance benefits and government pro with insurance and annuity contracts, insurance policies, including life insurance upon my life or the life of any other appropriate person and to make any elections and disclaimers under such polici; and the right 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. 7. To apply for, purchase, maintain and/or dealment, instrument or deed for such transactions. This includes the right to sell or encumber any homestead that I now own or may own in the future; the right to remove tenants and to recover possessionoper) deal with all, any part or any interest in any real or personal property or asset whatsoever, tangible or intangible (now owned or acquired in the future by me) and to execute any necessary docuest, to have, or use. 6. To maintain, manage, insure, lease, rent, sell, mortgage, improve, repair, exchange, invest, reinvest and in any other manner (on such terms and at prices my Agent may deem prts of title and demands whatsoever, whether agreed to or disputed, now due or due in the future, owned by, due, owing payable, or belonging to, me or in which I have or may hereafter acquire any interst any and all sums of money, accounts, debts, bonds, commercial papers, checks, drafts, causes of action, bequests, deposits, notes, interests, dividends, certificates of deposit, any and all documenect any amount or debt owed to me. 4. To adjust, compromise and settle any claim, against me or asserted on my behalf against any other person or entity. -2- 5. To receive, hold, possess and/or inve other debts and obligations and such other instruments in writing of whatever kind and nature as may be. 3. To request, ask, demand, sue and take any and all legal steps necessary to recover and collugh banks, savings and loan, brokers, mutual fund companies or other institutions, proofs of loss, evidences of debts, releases, and satisfaction of mortgages, lien, judgments, security agreements andpts, title documents, checks, drafts, letters of credit, stock certificates, proxies, warrants, commercial papers, withdrawal and deposit slips, certificates of deposit of, or investments with or throd to applications, assignments, bills of sale or lading, bonds, contracts, covenants, conveyances, deeds, options, trust deeds, security agreements, leases, mortgages, notes, insurance policies, recei2. To enter into binding contracts on my behalf and to sign, endorse and execute any written agreement and document necessary to enter into any such contract and/or agreement, including but not limitented. My Agent's powers and authority shall include, but not be limited to: 1. To conduct, engage in, and transact any and all lawful business of whatever kind or nature, on my behalf and in my name. resent. I hereby ratify and confirm all acts that my Agent, or my Agent's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights hereby gray later acquire in connection with or relating to any person, item, transaction, thing, business, property, real or personal, tangible or intangible, or matter whatsoever as I could do if personally pcessary, to serve with the same powers, rights and discretions. My Agent shall have full power and authority to perform any act, power, duty, legal right or obligation whatsoever that I now have or maable to serve for any reason, I appoint _____________________________________ maintaining an address at: _____________________________________________________ as my alternate or successor Agent, as ne_ ("Agent") maintaining an address at: _____________________________________________________ my true and lawful attorney-in-fact for me and in my name, and in my behalf. If the above named Agent is unENTS: I, ____________________________________ ("Principal") maintaining an address at _______________________________________________ do hereby make and appoint _______________________________________ny provision of it, then you should obtain the assistance of an attorney or other qualified person. -1- CALIFORNIA DURABLE POWER OF ATTORNEY Effective upon Disability KNOW ALL PERSONS BY THESE PRESy will give your agent the right to deal with property that you now have or might acquire in the future. The power of attorney is important to you. If you do not understand the power of attorney, or ay that may affect real property should be acknowledged before a notary public so that it may easily be recorded. You should read this power of attorney carefully. When effective, this power of attornenesses. 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 power of attorneright to revoke or terminate this power of attorney at any time, so long as you are competent. This power of attorney must be dated and must be acknowledged before a notary public or signed by two witthis power of attorney. You can amend or change this power of attorney only by executing a new power of attorney or by executing an amendment through the same formalities as an original. You have the wers you give your agent in this power of attorney will continue to exist even if you can no longer make your own decisions respecting the management of your property, unless you provide otherwise in gent will continue to exist for your entire lifetime, unless you state that the power of attorney will last for a shorter period of time or unless you otherwise terminate the power of attorney. The porney. Your agent will have the right to receive reasonable payment for services provided under this power of attorney unless you provide otherwise in this power of attorney. The powers you give your amanage, 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, unless you provide otherwise in this power of attoof 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 of Attorney Warning A power of attorney is an important legal document. By signing the power of attorney, you are authorizing another person to act for you, the principal. Before you sign this power information that is not state specific. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific instructions. -2- California Powercessary, if the Agent will deal with any real estate in Florida. Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, this information is generalttorney to be recorded as a public record, if necessary. Although, some states don't require that a Durable Power of Attorney be witnessed, it is always a very good idea to do so. Two witnesses are ne the Agent will be dealing with any real property. Notarization will make it more difficult for any third party to challenge the validity of the Power of Attorney and will allow the Durable Power of Aned, in the event the original Agent is unable to serve or continue to serve as the Agent. A Durable Power of Attorney should always be notarized, even if your state does not require it, especially ifat any time. Since this Durable Power of Attorney takes effect only after the Principal becomes disabled or incompetent, an alternate Agent can be designated, at the time this Power of Attorney is sigpal. This is especially important if the Principal is incapacitated when the Power of Attorney goes into effect, or the Agent undertakes the acts. The Principal can revoke a Durable Power of Attorney of Attorney is a "powerful" instrument and should be granted with care. Any action undertaken by the Agent, within the scope of the Power of Attorney document, will be legally binding upon the Princiused here to mean "lawyer". The person acting as the attorney-in-fact for the Principal does not need to be a lawyer. Almost anyone can be appointed an attorney-in-fact by a power of attorney. A Powern his or her behalf, even if the Principal later becomes incapacitated. This particular Form becomes effective upon the disability or incapacity of the Principal. Note that the word "attorney" is not isability A Durable Power of Attorney allows a natural "mentally competent " person (called the "Principal" or "Principal") to authorize someone else (called the "Agent" or "AttorneyIn-Fact") to act oocument with another party. The purchase and use of these forms, is subject to the Disclaimers and Terms of Use found at findlegalforms.com -1- Information Durable Power of Attorney Effective upon Dubstitute for legal advice. These forms should only be a starting point for you and should not be used without consulting with an attorney first. An Attorney should be consulted before negotiating a de as Agent is unable to serve or continue to serve as the Agent. This section can be removed, deleted (and initialed) or the words "no one" can be entered. These forms are not intended and are not a s sweeping, as the Agent has the power to handle business and legal matters on the Principal's behalf. This document offers the option of nominating an alternate Agent in the event that the first choicthe Agent (or attorney-in-fact) as to the tasks the Agent should complete. The Grantor should also be very careful in the selection of the Agent. The powers granted by this document are very broad andd not be a witness. The Principal should keep the original document, as well as a copy. The Agent should have access to the original document as needed. The Principal should be careful in instructing 1) the signing of the power of attorney or (2) the principal's signing or acknowledgment of his or her signature. Generally, anyone related by blood or marriage to the Principal, Agent or Notary shoulecord, if necessary. In California, the power of attorney must be dated and must be acknowledged before a notary public or signed by two witnesses. If two witnesses sign it, they must witness either (e Principal. The Principal (i.e. the person granting the Power of Attorney) should sign the document before a Notary. Notarization will allow the Durable Power of Attorney to be recorded as a public r Information for Durable Power of Attorney Effective upon Disability; (3) Durable Power of Attorney Effective upon Disability This Durable Power of Attorney becomes effective upon the Disability of thInstructions & Checklist California Durable Power of Attorney Effective upon Disability This package contains (1) Instructions & Checklist for Durable Power of Attorney Effective upon Disability; (2) CaliforniaCalifornia Y under the laws of the State of California that the foregoing paragraph is true and correct WITNESS my hand and official seal. Signature __________________________________ (Seal) -6- 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 PERJURn 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 _____________________________________________ (here insert name and title of the officer), personally appeared _____________________________ _______________________________________, who proved to me o__________________________________ State: ___________________________________ Notary Acknowledgment State of California County of ________________________ ) ) ss ) On __________ before me, ____________________ City: __________________________________ State: ___________________________________ Witness Signature: ___________________________________ Name: ___________________________________ City: _ (date), at _______________________ (city), California. ________________________________ Signature of Principal Witness Signature: ___________________________________ Name: ________________________nd/or willful misconduct, while acting under the authority of this Power of Attorney. I may revoke this Power of Attorney at any time by providing written notice to my Agent. Signed on _______________ held harmless. -5- Agent shall not be liable for losses resulting from judgment errors made in good faith. However, Agent will be liable for breach of fiduciary duty, failure to act in good faith apower of attorney. If this General Power of Attorney is terminated by operation of law, any person relying in good faith on the authority of this document, without notice of such termination, shall beve 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 /or (c) my assets to be subject to a general power of appointment by my Agent. Any third party who receives a copy of this document may act under it. Revocation of the power of attorney is not effectithe extent necessary to prevent (a) my income to be taxable to my Agent; (b) my Agent to have any rights or ownership with respect to any life insurance policies I may own on the life of my Agent; and the use or issuance of this power-ofattorney or as to the disposition of any proceeds paid to my Agent based on this document. The powers granted to my Agent by this power-of-attorney are limited to ble law, then the remaining unaffected parts of the document shall still remain in full force and effect and not be affected by any partial invalidity. No person needs to inquire as to the reasons for powers are not intended to restrict or limit the definition or scope of powers granted herein in any manner. If any part of this document is held to be invalid, illegal or unenforceable under applicaan accounting for all funds handled and all acts performed as my Agent. This Power of Attorney shall be construed broadly as a General Power of Attorney. The listing of specific terms, rights, acts or entitled to reasonable compensation for any services provided as my Agent If so requested by myself or any authorized personal representative or fiduciary acting on my behalf, my Agent shall provide ffairs properly. My Agent shall be entitled to reimbursement of all reasonable expenses incurred as a result of carrying out any provision of this Power of Attorney. If desired, my Agent shall also beity. As used herein, "disability" or "incapacity" shall mean a lack of capacity to receive and evaluate information effectively, to communicate decisions, and/or to manage my financial resources and ammediately upon execution of this instrument. The rights, powers, and -4- authority of this document shall remain in full force and effect thereafter until my death or until my disability or incapact is that the disclaimed assets pass directly or indirectly to my Agent or my Agent's estate. This General Power of Attorney and the rights, powers, and authority of my Agent shall become effective ight be transferred or distributed to me from any other person, estate, trust, or other entity, as may be appropriate. However, Agent may not disclaim assets, to which I would be entitled, if the resul my assets to the trustee of any revocable trust created by me, if such trust exists at the time of such transfer. 17. To disclaim any interest (subject to other provisions of this document), which mi to discharge any of my Agent's legal obligations, including any obligations of support which my Agent may owe to others, excluding those whom I am legally obligated to support. 16. To transfer any off my Agent's estate, (b) exercise any powers of appointment I may hold in favor of my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, or (c) use any of my assetshorized by this document, (a) gift, appoint, assign or designate any of my assets, interests or rights, directly or indirectly, to my Agent, my Agent's estate, my Agent's creditors, or the creditors otax annual exclusion amount in any one calendar year, and this annual right shall be non-cumulative and shall lapse at the end of each calendar year. However, my Agent may not, unless specifically autGifts to Minors Act or the Uniform Transfers To Minors Act. Any gifts made shall be limited to gifts that qualify for the federal gift tax annual exclusion, shall not exceed in value the federal gift necessary, to file any state and federal gift tax returns and documents. Gifts to minors may be made to the minor directly or parent, guardian or close friend of the minor or pursuant to the Uniform ritable contributions of my real, personal, tangible or intangible property, to such persons or organizations without regard to whether such gifts are a part of my estate planning or otherwise, and ifin or provide information to and from any agency, including governmental agencies, relating to tax matters and to negotiate, compromise or settle any matter with such agency. 15. To make gifts and chaocuments with any federal, state, local or other governmental body, including, but not limited to, federal, state, local or other income and tax returns and necessary and/or related documents; to obta as may be appropriate, including but not limited to, attorneys, accountants, investment professionals, brokers and real estate agents. 14. To prepare, or cause to be prepared, sign, and/or file any d-3- 12. To maintain and/or operate any business that I currently own or have an interest in or may own or have an interest in, in the future. 13. To employ any professional and/or business assistancemove, keep or otherwise dispose of the contents. 11. To exercise any and all rights, including proxy rights, with respect to stocks, bonds, debentures, commodities, options or any other investments. ies. 10. To have access to any safe deposit box, vault or other storage area owned or leased by me alone or in conjunction with any other person, including access to their contents, and to examine, reirm, corporation or political entity; to perform any act necessary to deposit, negotiate, sell or transfer any note, security, or draft of the United States of America, including U.S. Treasury Securitiating or endorsing any checks or other instruments, obtaining bank statements, passbooks, drafts, warrants, money orders, certificates, cashier checks, cash or vouchers payable to me by any person, fwith financial institutions; to conduct any business with any banking or financial institution with respect to any of my accounts, including, but not limited to, making deposits and withdrawals, negotnk accounts, including, but not limited to, checking accounts, savings accounts, certificates of deposit, investment accounts, brokerage accounts, retirement plan accounts, and other similar accounts nd social security benefits), and to appoint anyone, including my Agent, to act as my "Representative Payee" for the purpose of receiving Social Security benefits. 9. To open, maintain and/or close bapplications, provide information, and perform any other reasonable request by any government or its agencies in connection with governmental benefits (including but not limited to, medical, military apayments I receive from any annuity, pension, retirement benefits, retirement plans, insurance benefits and government program including, but not limited to, Social Security and Medicare; to prepare arance upon my life or the life of any other appropriate person and to make any elections and disclaimers under such policies. 8. To receive, deposit, hold, demand, deal with and/or sue to recover all monies which may become due and owing to me by reason of such transaction. 7. To apply for, purchase, maintain and/or deal with insurance and annuity contracts, insurance policies, including life insul or encumber any homestead that I now own or may own in the future; the right to remove tenants and to recover possession; and the right to ask for, demand, sue for, collect, recover and receive all or asset whatsoever, tangible or intangible (now owned or acquired in the future by me) and to execute any necessary document, instrument or deed for such transactions. This includes the right to selage, improve, repair, exchange, invest, reinvest and in any other manner (on such terms and at prices my Agent may deem proper) deal with all, any part or any interest in any real or personal property2- in the future, owned by, due, owing payable, or belonging to, me or in which I have or may hereafter acquire any interest, to have, or use. 6. To maintain, manage, insure, lease, rent, sell, mortgfts, causes of action, bequests, deposits, notes, interests, dividends, certificates of deposit, any and all documents of title and demands whatsoever, whether agreed to or disputed, now due or due -im, against me or asserted on my behalf against any other person or entity. 5. To receive, hold, possess and/or invest any and all sums of money, accounts, debts, bonds, commercial papers, checks, dra kind and nature as may be. 3. To request, ask, demand, sue and take any and all legal steps necessary to recover and collect any amount or debt owed to me. 4. To adjust, compromise and settle any claons, 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 whateverroxies, warrants, commercial papers, withdrawal and deposit slips, certificates of deposit of, or investments with or through banks, savings and loan, brokers, mutual fund companies or other institutienants, conveyances, deeds, options, trust deeds, security agreements, leases, mortgages, notes, insurance policies, receipts, title documents, checks, drafts, letters of credit, stock certificates, pte any written agreement and document necessary to enter into any such contract and/or agreement, including but not limited to applications, assignments, bills of sale or lading, bonds, contracts, cov To conduct, engage in, and transact any and all lawful business of whatever kind or nature, on my behalf and in my name. 2. To enter into binding contracts on my behalf and to sign, endorse and executitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights hereby granted. My Agent's powers and authority shall include, but not be limited to: 1.n, thing, business, property, real or personal, tangible or intangible, or matter whatsoever as I could do if personally present. I hereby ratify and confirm all acts that my Agent, or my Agent's subs have full power and authority to perform any act, power, duty, legal right or obligation whatsoever that I now have or may later acquire in connection with or relating to any person, item, transactio_________________ ("Agent") maintaining an address at: _____________________________________________________ my true and lawful attorney-in-fact for me and in my name, and in my behalf. My Agent shallNS BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an address at _______________________________________________ do hereby make and appoint _______________________ not understand the power of attorney, or any provision of it, then you should obtain the assistance of an attorney or other qualified person. -1- CALIFORNIA GENERAL POWER OF ATTORNEY KNOW ALL PERSOully. When effective, this power of attorney will give your agent the right to deal with property that you now have or might acquire in the future. The power of attorney is important to you. If you doof his or her signature. A 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 power of attorney carefbefore 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 e formalities as an original. You have the right to revoke or terminate this power of attorney at any time, so long as you are competent. This power of attorney must be dated and must be acknowledged property, unless you provide otherwise in this power of attorney. You can amend or change this power of attorney only by executing a new power of attorney or by executing an amendment through the samise terminate the power of attorney. The powers you give your agent in this power of attorney will continue to exist even if you can no longer make your own decisions respecting the management of yourwer of attorney. The powers you give your agent will continue to exist for your entire lifetime, unless you state that the power of attorney will last for a shorter period of time or unless you otherwyou provide otherwise in this power of attorney. Your agent will have the right to receive reasonable payment for services provided under this power of attorney unless you provide otherwise in this pois 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, unless the principal. Before you sign this 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. Thecific instructions. -2- California Power of Attorney Warning A power of attorney is an important legal document. By signing the power of attorney, you are authorizing another person to act for you,e. Furthermore, this information is general information that is not state specific. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state spt findlegalforms.com as well), stays in effect even if the Grantor later becomes disabled or incapacitated. Please note that this information is not intended as and is not a substitute for legal advicgh, some states don't require that a General Power of Attorney be witnessed, it is always a very good idea to do so. Another type of Power of Attorney, called a Durable Power of Attorneys (available a will make it more difficult for any third party to challenge the validity of the Power of Attorney and will allow the General Power of Attorney to be recorded as a public record, if necessary. Althouer of Attorney at any time. A General Power of Attorney should always be notarized, even if your state does not require it, especially if the Agent will be dealing with any real property. Notarization and should be granted with care. Any action undertaken by the Agent, within the scope of the Power of Attorney document, will be legally binding upon the Grantor. The Grantor can revoke a General PowPrincipal does not need to be a lawyer. Almost anyone can be appointed an Attorney-In-Fact by a power of attorney. The Agent should be a competent adult. A Power of Attorney is a "powerful" instrumenttil the death of the Grantor or until the Grantor becomes disabled or incapacitated. Note that the word "attorney" is not used here to mean "lawyer". The person acting as the Attorney-In-Fact for the e "Principal" or "Grantor") to authorize someone else (called the "Agent" or "Attorney-InFact") to act on his or her behalf. This particular Form becomes effective immediately and remains effective un subject to the Disclaimers and Terms of Use found at findlegalforms.com -1- Information General Power of Attorney A General Power of Attorney allows a natural "mentally" competent person (called thint for you and should not be used without consulting with an attorney first. An Attorney should be consulted before negotiating any document with another party. The purchase and use of these forms isthe Agent has the power to handle business and legal matters on the Principal's behalf. These forms are not intended and are not a substitute for legal advice. These forms should only be a starting poattorney-in-fact) as to the tasks the Agent should complete. The Grantor should also be very careful in the selection of the Agent. The powers granted by this document are very broad and sweeping, as sses. The Principal should keep the original document, as well as a copy. The Agent should have access to the original document as needed. The Principal should be careful in instructing the Agent (or either (1) the signing of the power of attorney or (2) the principal's signing or acknowledgment of his or her signature. The Agent, the Agent's spouse or children, and the Notary should not be witne public record, if necessary. In California, the power of attorney must be dated and must be acknowledged before a notary public or signed by two witnesses. If two witnesses sign it, they must witnesscipal (i.e. the person granting the Power of Attorney; sometimes called the Grantor) should sign the document before a Notary. Notarization will allow the General Power of Attorney to be recorded as aral Power of Attorney This General Power of Attorney becomes effective immediately and remains effective until the death of the Grantor or until the Grantor becomes disabled or incapacitated. The PrinInstructions & Checklist California General Power of Attorney This package contains (1) Instructions & Checklist for General Power of Attorney; (2) Information for General Power of Attorney; (3) Gene CaliforniaCalifornia ing paragraph is true and correct WITNESS my hand and official seal. Signature __________________________________ (Seal) -4- e 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 foregoose 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 thname and title of the officer), personally appeared _____________________________ _______________________________________, who proved to me on the basis of satisfactory evidence to be the person(s) wh___________________ Notary Acknowledgment State of California County of ________________________ ) ) ss ) On __________ before me, ______________________________________________________ (here insert : ___________________________________ Witness Signature: ___________________________________ Name: ___________________________________ City: __________________________________ State: ________________er ________________________________ Signature of Mother Witness Signature: ___________________________________ Name: ___________________________________ City: __________________________________ State at any time by providing written notice to the Attorney-in-Fact. Signed on ________________ (date), at _______________________ (city), California. ________________________________ Signature of Fathw, any person relying in good faith on the authority of this document, without notice of such termination, shall be held harmless. -3- We may revoke this Power of Attorney before the expiration dateation. We agree to indemnify the third party for any claims that arise against the third party because of reliance on this power of attorney. If this Power of Attorney is terminated by operation of la 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 revoce invalid, illegal or unenforceable under applicable law, then the remaining unaffected parts of the document shall still remain in full force and effect and not be affected by any partial invalidity.e Attorney-in-Fact shall be entitled to reimbursement of all reasonable expenses incurred as a result of carrying out any provision of this Power of Attorney. If any part of this document is held to bt of this grant of powers to the Attorney-in-Fact named herein. We hereby ratify and confirm all acts by the Attorney-in-Fact done by virtue of this power of attorney and the rights hereby granted. Thhall be in effect from _______________ to _______________ ("expiration date"). By signing here, we indicate that we are fully informed as to the contents of this document and understand the full imporprocedures for any child/children; (ii) have the power to consent to the marriage of our child/children; (iii) have the power to consent to the adoption of our child/children. This power of attorney slaims, agreements, contracts and legal documents. Notwithstanding other provisions in this Power of Attorney, Attorney-in-Fact shall not (i) have the authority to withhold or withdraw life sustaining ompany. 6. Endorse and execute any documents necessary for the performance of the powers granted by this document, including but not limited to consent forms, releases, waivers, insurance documents, cy for, purchase, maintain and/or deal with any health and other insurance for our child/children and to make and file any medical or other type of claim against any health or other type of insurance c, sue and take any and all legal steps necessary on behalf of our child/children and to adjust, compromise and settle any claim, our child/children may have against any other person or entity. 5. Appl customary living standard of the child/children, including, but not limited to, provisions of living quarters, food, clothing, entertainment and other customary matters. -2- 4. Request, ask, demandctivities; review any school records of the child/children; allow our child/children to participate in activities and events offered by any group, organization or educational facility. 3. Maintain thef operations, diagnostic and other procedures. 2. Determine the education of our child/children and to register and enroll our child/children in any educational programs, schools and extracurricular a incident to the provision of medical, surgical or dental care to our child/children. Health care shall include but not be limited to the administration of anesthesia, X-ray examination, performance o for such health care; review and if necessary disclose the contents of any medical records; execute any consent, release or waiver of liability required by medical, dental or other health authoritieshe powers to: 1. Provide for, approve, authorize and decline any health care at any hospital or other institution; employ any physicians, dentists, nurses, or other person whose services may be neededhority to act entirely in loco parentis and to do all acts necessary or desirable for maintaining the health, education, and welfare of our above named child/children, including, but not limited to, t_ born on __________ Name: _________________________________ born on __________ Name: _________________________________ born on __________ The above named Attorney-in-Fact shall have the power and aut________________________ born on __________ Name: _________________________________ born on __________ Name: _________________________________ born on __________ Name: ________________________________________________________________________ as our true and lawful agent and attorney-in-fact for us and in our name, and in our behalf to act as the guardian of our minor child/children: Name: _________als", maintaining an address at: ________________________________________ hereby make and appoint ________________________________________ ("Attorney-in-Fact") maintaining an address at: _____________ ALL PERSONS BY THESE PRESENTS: We ______________________________________________________ ("Father") and ______________________________________ ("Mother"), jointly referred to as "Parents" or "Principu do not understand the power of attorney, or any provision of it, then you should obtain the assistance of an attorney or other qualified person. -1- POWER OF ATTORNEY FOR THE CARE OF CHILDREN KNOWaffect real property should be acknowledged before a notary public so that it may easily be recorded. You should read this power of attorney carefully. The power of attorney is important to you. If yo. If it is signed by two witnesses, they must witness either (1) the signing of the power of attorney or (2) the principals' signing or acknowledgment of their signature. A power of attorney that may to revoke or terminate this power of attorney at any time, so long as you are competent. This power of attorney must be dated and must be acknowledged before a notary public or signed by two witnessesower of attorney. You can amend or change this power of attorney only by executing a new power of attorney or by executing an amendment through the same formalities as an original. You have the right ided under this power of attorney unless you provide otherwise in this power of attorney. The powers you give your agent will continue until the expiration date or unless you otherwise terminate the pe important facts: Your agent (attorney-in-fact) has no duty to act unless you and your agent agree otherwise in writing. Your agent will have the right to receive reasonable payment for services provttorney is an important legal document. By signing the power of attorney, you are authorizing another person to act for you, the principal. Before you sign this power of attorney, you should know thesecific. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific instructions. -2- California Power of Attorney Warning A power of aways a very good idea to do so. Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general information that is not state spit. Notarization will make it more difficult for any third party to challenge the validity of the Power of Attorney. Although, some states don't require that a Power of Attorney be witnessed, it is al" date, the Parents can revoke the document at any time even before the expiration date. The Power of Attorney for the Care of Children should always be notarized, even if your state does not require nts should also be careful in instructing the Attorney-in-Fact as to what the Attorney-in-Fact should do. Although the Power of Attorney for the Care of Children has a beginning and an "end/expirationould be very careful in the selection of the Attorney-in-Fact, as the powers granted by this document are very broad and sweeping and the children are being entrusted to the Attorney-in-Fact. The Pareranging for medical, dental or any other type of care. Medical personnel will also generally feel more comfortable dealing with an Attorney-inFact who can provide this type of document. The Parents sht. By having this type of document available, the Attorney-in-Fact will be able to better deal with any types of emergency involving the children and can avoid potential problems when, for example, ar be useful if the parent will be absent for a period of time. The powers granted by this instrument are very broad. Parents are basically giving temporary custody of the children to the Attorney-infacorney-in-Fact by a power of attorney. This form allows the Attorney-in-Fact to make decisions for the children in place of the parents, including health care, education and welfare decisions. This canen. The word "attorney" is not used here to mean "lawyer". The person acting as the Attorney-in-Fact for the Parents or the children does not need to be a lawyer. Almost anyone can be appointed an Att can be used. This document allows parents of one or more children (sometimes called the "Principals" or "Grantors") to appoint another person to act as their Attorney-in-Fact to care for their childr Information Power of Attorney for the Care of Children Whenever it becomes necessary to allow someone else to provide for the care of your children, a Power of Attorney for the Care of Children forming point for you and should not be used without consulting with an attorney first. The purchase and use of these forms, is subject to the Disclaimers and Terms of Use found at findlegalforms.com -1- of the Attorney-in-Fact, as the powers granted by this document are very broad and sweeping. These forms are not intended and are not a substitute for legal advice. These forms should only be a startn-Fact's spouse or children, and the Notary should not be witnesses. The Parents should be careful giving instructions to the Attorney-in-Fact. The Parents should also be very careful in the selectionses. If two witnesses sign it, they must witness either (1) the signing of the power of attorney or (2) the Parents' signing or acknowledgment of their signatures. The Attorney-in-Fact, the Attorney-iof the Power of Attorney for the Care of Children document for their records. In California, the power of attorney must be dated and must be acknowledged before a notary public or signed by two witnesof Attorney for the Care of Children document before a Notary. The original Power of Attorney for the Care of Children document should be given to the Attorney-in-Fact. The Parents should keep a copy ) additional useful information about Power of Attorney for the Care of Children documents. Both Parents need to sign the Power of Attorney for the Care of Children. The Parents should sign the Power Instructions & Checklist California Power of Attorney for the Care of Children This package contains a (1) Power of Attorney for the Care of Children; (2) simple instructions plus a checklist; and (3 CaliforniaCalifornia _____________________________________________ State: _____________________________________________ Source: findlegalforms.com 7 Initials ______ ____________________________________ Sign your name _____________________________________ Print your name: ___________________________________ Address: __________________________________________ City:n as designated by the State Department of Aging and that I am serving as a witness as required by Section 4675 of the Probate Code. Date: _____________________________________________ Name: ________nt: STATEMENT OF PATIENT ADVOCATE OR OMBUDSMAN Source: findlegalforms.com 6 Initials ______ I declare under penalty of perjury under the laws of California that I am a patient advocate or ombudsmalled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis. The patient advocate or ombudsman must sign the following stateme - SPECIAL WITNESS REQUIREMENT (6.1) The following statement is required only if you are a patient in a skilled nursing facility--a health care facility that provides the following basic services: skitate upon his or her death under a will now existing or by operation of law. Signature of Witness: ___________________________________ Signature of Witness: ___________________________________ PART 6t I am not related to the individual executing this advance health care directive by blood, marriage, or adoption, and to the best of my knowledge, I am not entitled to any part of the individual's es____ (5.4) ADDITIONAL STATEMENT OF WITNESSES: At least one of the above witnesses must also sign the following declaration: I further declare under penalty of perjury under the laws of California tha__________________________________________ Address: ___________________________________________ Signature of Witness: _________________________________ Date: ______________________________________________________ Address: ___________________________________________ Signature of Witness: _________________________________ Date: ______________________________________________ SECOND WITNESS Name: ___lity, the operator of a residential care facility for the elderly, nor an employee of an operator of a residential care facility for the elderly. FIRST WITNESS Name: _________________________________ am not the individual's health care provider, an employee of the individual's health care provider, the operator of a community care facility, an employee of an operator of a of a community care facie of sound mind and under no duress, fraud, or undue influence, (4) that I am not a person appointed as Source: findlegalforms.com 5 Initials ______ agent by this advance directive, and (5) that Ime, or that the individual's identity was proven to me by convincing evidence (2) that the individual signed or acknowledged this advance directive in my presence, (3) that the individual appears to b3) STATEMENT OF WITNESSES: I declare under penalty of perjury under the laws of California (1) that the individual who signed or acknowledged this advance health care directive is personally known to ___________________________________ Address ____________________________________________ City _______________________________________________ State _______________________________________________ (5.ame effect as the original. (5.2) SIGNATURE: Sign and date the form here: Date: ______________________________________________ Sign your name ______________________________________ Print your name ___ State, Zip Code: ___________________________________________________ Phone: _______________________________________________________________ PART 5 (5.1) EFFECT OF COPY: A copy of this form has the se the following physician as my primary physician: Name of physician: _____________________________________________________ Address: _____________________________________________________________ City,____________________________________________________________ OPTIONAL: If the physician I have designated above is not willing, able, or reasonably available to act as my primary physician, I designat___________________________________________ Address: _____________________________________________________________ City, State, Zip Code: ___________________________________________________ Phone: ___t want): (1) Transplant (2) Therapy (3) Research (4) Education PART 4 - PRIMARY PHYSICIAN - (OPTIONAL) (4.1) I designate the following physician as my primary physician: Name of physician: _______________________________________________________________________________ (c) My gift is for the following purposes (strike any of the Source: findlegalforms.com 4 Initials ______ following you do no DEATH - (OPTIONAL) (3.1) Upon my death (mark applicable box): (a) I give any needed organs, tissues, or parts, OR (b) I give the following organs, tissues, or parts only: _________________________ ________________________________________________________________ ______________________________________________________________________ (Add additional sheets if needed.) PART 3 - DONATION OF ORGANS ATES: (If you do not agree with any of the optional choices above and wish to write your own, or if you wish to add to the instructions you have given above, you may do so here.) I direct that: ________death: ______________________________________________________________________ ______________________________________________________________________ (Add additional sheets if needed.) (2.3) OTHER WISH health care standards. (2.2) RELIEF FROM PAIN: Except as I state in the following space, I direct that treatment for alleviation of pain or discomfort be provided at all times, even if it hastens my the likely risks and burdens of treatment would outweigh the expected benefits, OR (b) Choice To Prolong Life I want my life to be prolonged as long as possible within the limits of generally accepted irreversible condition that will result in my death within a relatively short time, (2) I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or (3) my care provide, withhold, or withdraw treatment in accordance with the choice I have marked below: (a) Choice Not To Prolong Life I do not want my life to be prolonged if (1) I have an incurable andart of the form, you may strike any wording you do not want. Source: findlegalforms.com 3 Initials ______ (2.1) END-OF-LIFE DECISIONS: I direct that my health care providers and others involved in willing, able, or reasonably available to act as conservator, I nominate the alternate agents whom I have named, in the order designated. PART 2 - INSTRUCTIONS FOR HEALTH CARE If you fill out this padditional sheets if needed.) (1.6) NOMINATION OF CONSERVATOR: If a conservator of my person needs to be appointed for me by a court, I nominate the agent designated in this form. If that agent is not____________________________________________________ ______________________________________________________________________ ______________________________________________________________________ (Add S POSTDEATH AUTHORITY: My agent is authorized to make anatomical gifts, authorize an autopsy, and direct disposition of my remains, except as I state here or in Part 3 of this form: __________________ for me in accordance with what my agent determines to be in my best interest. In determining my best interest, my agent shall consider my personal values to the extent known to my agent. (1.5) AGENT'ney for health care, any instructions I give in Part 2 of this form, and my other wishes to the extent known to my agent. To the extent my wishes are unknown, my agent shall make health care decisionsox my agent's authority to make health care decisions for me takes effect immediately. (1.4) AGENT'S OBLIGATION: My agent shall make health care decisions for me in accordance with this power of attorTY BECOMES EFFECTIVE: My agent's authority ecomes effective when my primary physician determines that I am unable to make my own health care decisions unless I mark the following box. If I mark this b___________________________________________________________________ ______________________________________________________________________ (Add additional sheets if needed.) (1.3) WHEN AGENT'S AUTHORI, or withdraw artificial nutrition and hydration and all other forms of health care to keep me alive, except as I state here: ______________________________________________________________________ ______________________ (1.2) AGENT'S AUTHORITY: My agent is authorized to make all health care Source: findlegalforms.com 2 Initials ______ decisions for me, including decisions to provide, withhold__ Address: _____________________________________________________________ City, State, Zip Code: ___________________________________________________ Phone Home _____________________ Work: ____________s willing, able, or reasonably available to make a health care decision for me, I designate as my second alternate agent: Name of individual you choose as second alternate agent: ___________________________________________________________ Phone Home _____________________ Work: ______________________________ OPTIONAL: If I revoke the authority of my agent and first alternate agent or if neither iernate agent: Name of individual you choose as alternate agent: ____________________________ Address: _____________________________________________________________ City, State, Zip Code: ________________________________________ OPTIONAL: If I revoke my agent's authority or if my agent is not willing, able, or reasonably available to make a health care decision for me, I designate as my first alt____________ Address: _____________________________________________________________ City, State, Zip Code: ___________________________________________________ Phone Home _____________________ Work: __RNEY FOR HEALTH CARE (1.1) DESIGNATION OF AGENT: I designate the following individual as my agent to make health care decisions for me: Name of individual you choose as agent: ________________________t he or she understands your wishes and is willing to take the responsibility. You have the right to revoke this advance health-care directive or replace this form at any time. PART 1 - POWER OF ATTOovider you may have, to any health-care institution at which you are receiving care and to any health-care agents you have named. You should talk to the person you have named as agent to make sure tha form at the end. The form must be signed by two qualified witnesses or acknowledged before a notary public. Give a copy of the signed and completed form to your physician, to any other health-care pr. Source: findlegalforms.com 1 Initials ______ Part 4 of this form lets you designate a physician to have primary responsibility for your health care. After completing this form, sign and date thebest for you in making end-of-life decisions, you need not fill out Part 2 of this form. Part 3 of this form lets you express an intention to donate your bodily organs and tissues following your deathovision of pain relief. Space is also provided for you to add to the choices you have made or for you to write out any additional wishes. If you are satisfied to allow your agent to determine what is alth care, whether or not you appoint an agent. Choices are provided for you to express your wishes regarding the provision, withholding or withdrawal of treatment to keep you alive, as well as the prg cardiopulmonary resuscitation. (e) Make anatomical gifts, authorize an autopsy, and direct disposition of remains. Part 2 of this form lets you give specific instructions about any aspect of your heagnostic tests, surgical procedures, and programs of medication. (d) Direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of health care, includin, treatment, service or procedure to maintain, diagnose or otherwise affect a physical or mental condition. (b) Select or discharge health-care providers and institutions. (c) Approve or disapprove diur agent for all health-care decisions that may have to be made. If you choose not to limit the authority of your agent, your agent will have the right to: (a) Consent or refuse to consent to any careent, your agent may make all health-care decisions for you. This form has a place for you to limit the authority of your agent. You need not limit the authority of your agent if you wish to rely on yoyour agent is related to you or is a coworker. Additionally, you should consult an attorney before designating your conservator as your agent.) Unless the form you sign limits the authority of your agity care facility or a residential care facility where you are receiving care, or your supervising health care provider or employee of the health care institution where you are receiving care, unless may also name an alternate agent to act for you if your first choice is not willing, able or reasonably available to make decisions for you. (Your agent may not be an operator or employee of a commun agent to make health-care decisions for you if you become incapable of making your own decisions or if you want someone else to make those decisions for you now even though you are still capable. Youhis form, you may complete or modify all or any part of it. You are free to use a different form. Part 1 of this form is a Power of Attorney for Health Care. Part 1 lets you name another individual ase decisions for you. This form lets you do either or both of these things. It also lets you express your wishes regarding donation of organs and the designation of your primary physician. If you use tADVANCE HEALTH CARE DIRECTIVE (California Probate Code Section 4701) You have the right to give instructions about your own health care. You also have the right to name someone else to make health-car California