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Pennsylvania e specified time or contingency has occurred. -6- ivorce and that, if applicable, the specified future time or contingency has occurred, is conclusive proof of the nonrevocation or nontermination of the power at that time and conclusive proof that tht he did not have at the time of exercise of the power actual knowledge of the termination of the power by revocation, death or, if applicable, disability or incapacity or the filing of an action in d___________________________ Signature of Agent _______________________________ Date -5- 20 Pa.C.S.A. Section 5606 states that an affidavit executed by the agent under a power of attorney stating tha principal separate from my assets. I shall exercise reasonable caution and prudence. I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal. ___ence of a specific provision to the contrary in the power of attorney or in 20 Pa.C.S. when I act as agent: I shall exercise the powers for the benefit of the principal. I shall keep the assets of theknowledgment by Agent I, ___________________________________, have read the attached power of attorney and am the person identified as the Agent for the Principal. I hereby acknowledge that in the abs_____________ as identification. _________________________________ Signature of person taking acknowledgment (Notary Public) _________________________________ Name typed, printed, or stamped -4- Acument was acknowledged before me this _____ day of ____________________, ______ by __________________________ (name of Principal), who is personally known to me or who has produced _______________________________________________ City: __________________________________ State: ___________________________________ State of PENNSYLVANIA ) ) ss County of ________________________ ) The foregoing instr_____ Name: ___________________________________ City: __________________________________ State: ___________________________________ Witness Signature: ___________________________________ Name: _______my Agent. Signed on ________________ (date), at _______________________ (city), Pennsylvania. ________________________________ Signature of Principal Witness Signature: ______________________________ailure to act in good faith and/or willful misconduct, while acting under the authority of this Power of Attorney. -3- I may revoke this Power of Attorney at any time by providing written notice to otice of such termination, shall be held harmless. 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, f 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 faith on the authority of this document, without nhe power of attorney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree to indemnify the third party for any claims that arise against the thirday 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 of this document may act under it. Revocation of ts 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 ownership with respect to any life insurance policies I mds 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 this document. The powers granted to my Agent by thiegal 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. No person nee 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 any part of this document is held to be invalid, ill 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 broadly as a General Power of Attorney. The listing desired, my Agent shall also be 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 myhstanding the lapse of time since its execution. 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. Iff capacity to receive and evaluate information effectively, to communicate decisions, and/or to manage my financial resources and affairs properly. This Durable Power of Attorney shall be valid notwithall not terminate on my subsequent disability, incapacity or lack of mental competence (except as provided by any applicable statute). As used herein, "disability" or "incapacity" shall mean a lack o immediately upon execution of this instrument. The rights, powers, and authority of this document shall be exercisable notwithstanding my subsequent disability or incapacity. This Power of Attorney s" 22. "To pursue tax matters." 23. "To make an anatomical gift of all or part of my body." -2- This Durable Power of Attorney and the rights, powers, and authority of my Agent shall become effectiven insurance transactions." 18. "To engage in retirement plan transactions." 19. "To handle interests in estates and trusts." 20. "To pursue claims and litigation." 21. "To receive government benefits.s transactions." 13. "To engage in commodity and option transactions." 14. "To engage in banking and financial transactions." 15. "To borrow money." 16. "To enter safe deposit boxes." 17. "To engage i authorize medical and surgical procedures." 10. "To engage in real property transactions." 11. "To engage in tangible personal property transaction." 12. "To engage in stock, bond and other securitiesitions." "To withdraw and receive the income or corpus of a trust." "To authorize my admission to a medical, nursing, residential or similar facility and to enter into agreements for my care." 9. "Toy benefit." "To make additions to an existing trust for my benefit." "To claim an elective share of the estate of my deceased spouse." "To disclaim any interest in property." "To renounce fiduciary poo any or all of the following, each of which is defined in 20 Pa.C.S.A.5603 (relating to implementation of power of attorney): 1. 2. 3. 4. 5. 6. 7. 8. "To make limited gifts." "To create a trust for mAgent's substitute 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 empower him (her) to d, transaction, 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 shall 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_____________________________ ("Agent") maintaining an address at: _____________________________________________________ my true and lawful attorney-in-fact for me and in my name, and in my behalf. MyOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an address at _______________________________________________ do hereby make and appoint ___________AND I UNDERSTAND ITS CONTENTS. _________________________________ Signature of Principal / Grantor _________________________________ Name of Principal / Grantor __________________________ Date -1- KNN 20 PA.C.S. CH. 56. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU. I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE YOUR AGEN'TS FUNDS. A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR AGENT IS NOT ACTING PROPERLY. THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY ARE EXPLAINED MORE FULLY ID, UNLESS YOU EXPRESSLY LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY. YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM GENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY. YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME INCAPACITATEEAL OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE EXERCISED, YOUR A/ GRANTOR: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE DISPOSE OF ANY Rg or acting under the appointment, the agent assumes the fiduciary and other legal responsibilities of an agent. -4- PENNSYLVANIA DURABLE POWER OF ATTORNEY Effective Immediately NOTICE TO PRINCIPAL tent legal advice. This document does not authorize anyone to make medical and other health-care decisions for you. You may revoke this power of attorney if you later wish to do so. AGENT: By acceptinof your property. Any such action undertaken by your agent, within the scope of this power of attorney document, is legally binding upon you. If you have any questions about these powers, obtain compeonsider its consequences. You ("principal") are providing another person ("agent") with the power to handle business and legal matters on your behalf, including the power to sell, mortgage or dispose offered for sale, generally include state specific instructions. -3- CAUTION! PRINCIPAL: The Powers granted by this power of attorney document are broad and sweeping. Before signing this document, cd as and is not a substitute for legal advice. Furthermore, this information is general information that is not state specific. Whenever appropriate, the instructions included with the forms packages 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. Please note that this information is not intendeith 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 Attorney to be recorded as a he Grantor can revoke a Durable Power of Attorney at any time. A Durable Power of Attorney should always be notarized, even if your state does not require it, especially if the Agent will be dealing wAttorney 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 Grantor. Tng 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. The Agent should be a competent adult. A Power of immediately and remains in full force and effect even if the Principal (i.e. the Grantor) later becomes incapacitated. Note that the word "attorney" is not used here to mean "lawyer". The person actior "Grantor") to authorize someone else (called the "Agent" or "Attorney-InFact") to act on his or her behalf, even if the Principal later becomes incapacitated. This particular Form becomes effective of Use found at findlegalforms.com. -2- Information Durable Power of Attorney Effective Immediately A Durable Power of Attorney allows a natural "mentally" competent person (called the "Principal" ulting with -1- an attorney first. An Attorney should be consulted before negotiating any document with another party. [_] The purchase and use of these forms is subject to the Disclaimers and Termsl 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 point for you and should not be used without conscomplete. 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 the Agent has the power to handle business and legae Agent should be prepared to make copies for different transactions he undertakes. [_] The Principal should be careful in instructing the Agent (or attorney-in-fact) as to the tasks the Agent should hould keep the original document, as well as a copy. The Agent should have access to the original document as needed. The Agent could also have an original document (i.e. with original signatures). Thnt. The Agent shall exercise reasonable caution and prudence. The Agent shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the Principal. [_] The Principal st at the bottom of the Power of Attorney document. The Agent shall exercise the powers for the benefit of the Principal. The Agent shall keep separate the assets of the Principal from those of the Agerded as a public record, if necessary. [_] The Principal must also sign the "Notice to Principal" at the beginning of the Power of Attorney document. [_] The Agent will have to sign the Acknowledgemenby blood or marriage to the Principal, Agent or Notary. Although not necessary, signing the document before a Notary is suggested. Notarization will also allow the Durable Power of Attorney to be recoom is 18 years of age or older. A witness shall not be the individual who signed the power of attorney on behalf of and at the direction of the principal. Furthermore, witnesses should not be related wer of Attorney is executed by mark (when the Principal is incapable of signing) or by another individual (at the direction of the Principal), then it shall be witnessed by two individuals, each of whe even if the Principal (i.e. the Grantor) becomes subsequently incapacitated. [_] The Principal (i.e. the person granting the power of Attorney) must be mentally competent. In Pennsylvania, if the Poformation for Durable Power of Attorney Effective Immediately; (3) Durable Power of Attorney Effective Immediately [_] This Durable Power of Attorney becomes effective immediately and remains effectivInstructions & Checklist Pennsylvania Durable Power of Attorney Effective Immediately [_] This package contains (1) Instructions & Checklist for Durable Power of Attorney Effective Immediately; (2) In Pennsylvania