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Pennsylvania wer at that time and conclusive proof that the specified time or contingency has occurred. -6- or incapacity or the filing of an action in divorce and that, if applicable, the specified future time or contingency has occurred, is conclusive proof of the nonrevocation or nontermination of the poe agent under a power of attorney stating that 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 disbursements on behalf of the principal. ______________________________ Signature of Agent _______________________________ Date -5- 20 Pa.C.S.A. Section 5606 states that an affidavit executed by ththe principal. I shall keep the assets of the 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 incipal. I hereby acknowledge that in the absence 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 ____ Name typed, printed, or stamped -4- Acknowledgment by Agent I, ___________________________________, have read the attached power of attorney and am the person identified as the Agent for the Prto me or who has produced ________________________________ as identification. _________________________________ Signature of person taking acknowledgment (Notary Public) ____________________________________________________ ) The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by __________________________ (name of Principal), who is personally known _______________________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ State of PENNSYLVANIA ) ) ss County of _ess Signature: ___________________________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ Witness Signature: ____y at any time by providing written notice to my Agent. Signed on ________________ (date), at _______________________ (city), Pennsylvania. ________________________________ Signature of Principal Witnill 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. -3- I may revoke this Power of Attorne on the authority of this document, without notice of such termination, shall be held harmless. Agent shall not be liable for losses resulting from judgment errors made in good faith. However, Agent wy for any claims that arise against the third party because of reliance on this power of attorney. If this General Power of Attorney is terminated by operation of law, any person relying in good faithis 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 third partth 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 of thcument. 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 ownership wicted 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 this dot 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 be affey 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 any parersonal 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 broadl 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 authorized pctively, 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 carryingility or incapacity, or upon my revocation of this document, whichever occurs first. As used herein, "disability" or "incapacity" shall mean a lack of capacity to receive and evaluate information effe__________________________ ("Termination Date"), unless terminated earlier. The powers, rights and authority of this document shall terminate on the Termination date or in the event of my death, disabeneral Power of Attorney and the rights, powers, and authority of my Agent shall become effective immediately upon execution of this instrument. This power of Attorney shall continue effective until _ estates and trusts." 20. "To pursue claims and litigation." 21. "To receive government benefits." 22. "To pursue tax matters." 23. "To make an anatomical gift of all or part of my body." -2- This Gnancial transactions." 15. "To borrow money." 16. "To enter safe deposit boxes." 17. "To engage in insurance transactions." 18. "To engage in retirement plan transactions." 19. "To handle interests inage in tangible personal property transaction." 12. "To engage in stock, bond and other securities transactions." 13. "To engage in commodity and option transactions." 14. "To engage in banking and fidical, nursing, residential or similar facility and to enter into agreements for my care." 9. "To authorize medical and surgical procedures." 10. "To engage in real property transactions." 11. "To eng estate of my deceased spouse." "To disclaim any interest in property." "To renounce fiduciary positions." "To withdraw and receive the income or corpus of a trust." "To authorize my admission to a me of power of attorney): 1. 2. 3. 4. 5. 6. 7. 8. "To make limited gifts." "To create a trust for my benefit." "To make additions to an existing trust for my benefit." "To claim an elective share of theorney and the rights hereby granted. My Agent's powers and authority shall empower him (her) to do any or all of the following, each of which is defined in 20 Pa.C.S.A.5603 (relating to implementationr 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 do or cause to be done by virtue of this power of atthatsoever that I now have or may later acquire in connection with or relating to any person, item, transaction, thing, business, property, real or personal, tangible or intangible, or matter whatsoeve_________________ 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 perform any act, power, duty, legal right or obligation waddress at _______________________________________________ do hereby make and appoint ________________________________________ ("Agent") maintaining an address at: ________________________________________________________________ Name of Principal / Grantor __________________________ Date -1- KNOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU. I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE AND I UNDERSTAND ITS CONTENTS. _________________________________ Signature of Principal / Grantor _____ PROPERLY. THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY ARE EXPLAINED MORE FULLY IN 20 PA.C.S. CH. 56. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY. YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR AGEN'TS FUNDS. A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR AGENT IS NOT ACTINGT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME INCAPACITATED, UNLESS YOU EXPRESSLY LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTINGNOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE EXERCISED, YOUR AGENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY. YOUR AGENAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THIS POWER OF ATTORNEY DOES nd other legal responsibilities of an agent. -4- GENERAL POWER OF ATTORNEY NOTICE TO PRINCIPAL / GRANTOR: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROedical and other health-care decisions for you. You may revoke this power of attorney if you later wish to do so. AGENT: By accepting or acting under the appointment, the agent assumes the fiduciary ahe scope of this power of attorney document, is legally binding upon you. If you have any questions about these powers, obtain competent legal advice. This document does not authorize anyone to make mrson ("agent") with the power to handle business and legal matters on your behalf, including the power to sell, mortgage or dispose of your property. Any such action undertaken by your agent, within t- CAUTION! PRINCIPAL: The Powers granted by this power of attorney document are broad and sweeping. Before signing this document, consider its consequences. You ("principal") are providing another peormation is general information that is not state specific. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific instructions. -3, which stay 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 advice. Furthermore, this inf are other types of Power of Attorney forms available at findlegalforms.com as well, including General Power of Attorney forms (without a termination date), and various Durable Power of Attorney Formseral Power of Attorney to be recorded as a public record, if necessary. Although, some states don't require that a General Power of Attorney be witnessed, it is always a very good idea to do so. There, especially if 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 Genwill be legally binding upon the Grantor. The Grantor can revoke a General Power of Attorney at any time. A General Power of Attorney should always be notarized, even if your state does not require itnt 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, within the scope of the Power of Attorney document, 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 an Attorney-In-Fact by a power of attorney. The Agete as defined in the document or in the event of the death, disability, incapacity of the Grantor or if the Grantor revokes the document (whichever occurs first). Note that the word "attorney" is not " 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 until a set dafound at findlegalforms.com -2- Information General Power of Attorney (with specific termination date) A General Power of Attorney allows a "mentally" competent natural person (called the "Principalting with 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 Terms of Use s on the Principal's behalf. -1- [_] 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 consul. 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 legal matterould be prepared to make copies for different transactions he undertakes. [_] The Principal should be careful in instructing the Agent (i.e. Attorney-in-Fact) as to the tasks the Agent should complete 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). The Agent shent 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 should keepottom 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 Agent. The Agary. [_] The Principal must also sign the "Notice to Principal" at the beginning of the Power of Attorney document. [_] The Agent (i.e. Attorney in Fact) will have to sign the Acknowledgement at the be Principal, Agent or Notary. Although not necessary, signing the document before a Notary is suggested. Notarization will also allow the Power of Attorney to be recorded as a public record, if necesslder. 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 by blood or marriage to thd 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 whom is 18 years of age or ocipal revokes the document (whichever occurs first). [_] The Principal (i.e. the person granting the power of Attorney) must be mentally competent. In Pennsylvania, if the Power of Attorney is executeecomes effective immediately and remains effective until (a) a set date as defined by you in the document; or (b) in the event of the death, disability, incapacity of the Principal; or (c) if the Prinmination date); (2) Information for General Power of Attorney (with specific termination date); (3) General Power of Attorney Form (with specific termination date) [_] This General Power of Attorney bInstructions & Checklist Pennsylvania General Power of Attorney (with specific termination date) [_] This package contains (1) Instructions & Checklist for General Power of Attorney (with specific ter Pennsylvania