New York GOB Code § 5-1513

Statutory short form power of attorney
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§ 5-1513. Statutory short form power of attorney. The use of the\nfollowing form, or one which substantially conforms to the following\nform, in the creation of a power of attorney is lawful, and, when used,\nand executed in accordance with subdivision one of section 5-1501B of\nthis title, it shall be construed as a statutory short form power of\nattorney in accordance with the provisions of this title; provided\nhowever, that any section indicated as "Optional" which is not used may\nbe omitted and replaced by the words "Intentionally Omitted":\n            "POWER OF ATTORNEY NEW YORK STATUTORY SHORT FORM\n  (a) CAUTION TO THE PRINCIPAL: Your Power of Attorney is an important\ndocument. As the "principal," you give the person whom you choose (your\n"agent") authority to spend your money and sell or dispose of your\nproperty during your lifetime without telling you. You do not lose your\nauthority to act even though you have given your agent similar\nauthority.\n  When your agent exercises this authority, he or she must act according\nto any instructions you have provided or, where there are no specific\ninstructions, in your best interest. "Important Information for the\nAgent" at the end of this document describes your agent's\nresponsibilities.\n  Your agent can act on your behalf only after signing the Power of\nAttorney before a notary public.\n  You can request information from your agent at any time. If you are\nrevoking a prior Power of Attorney, you should provide written notice of\nthe revocation to your prior agent(s) and to any third parties who may\nhave acted upon it, including the financial institutions where your\naccounts are located.\n  You can revoke or terminate your Power of Attorney at any time for any\nreason as long as you are of sound mind. If you are no longer of sound\nmind, a court can remove an agent for acting improperly.\n  Your agent cannot make health care decisions for you. You may execute\na "Health Care Proxy" to do this.\n  The law governing Powers of Attorney is contained in the New York\nGeneral Obligations Law, Article 5, Title 15. This law is available at a\nlaw library, or online through the New York State Senate or Assembly\nwebsites, www.nysenate.gov or www.nyassembly.gov.\n  If there is anything about this document that you do not understand,\nyou should ask a lawyer of your own choosing to explain it to you.\n(b) DESIGNATION OF AGENT(S):\nI, _______________________________________________, hereby appoint:\n      name and address of principal\n_____________________________________________________as my agent(s)\n      name(s) and address(es) of agent(s)\n  If you designate more than one agent above and you do not initial the\nstatement below, they must act together.\n      ( ) My agents may act SEPARATELY.\n(c) DESIGNATION OF SUCCESSOR AGENT(S): (OPTIONAL)\n  If any agent designated above is unable or unwilling to serve, I\nappoint as my successor agent(s):\n  _______________________________________________________________\n  name(s) and address(es) of successor agent(s)\n  If you do not initial the statement below, successor agents designated\nabove must act together.\n      ( ) My successor agents may act SEPARATELY.\n  You may provide for specific succession rules in this section. Insert\nspecific succession provisions here:\n(d) This POWER OF ATTORNEY shall not be affected by my subsequent\nincapacity unless I have stated otherwise below, under "Modifications".\n(e) This POWER OF ATTORNEY DOES NOT REVOKE any Powers of Attorney\npreviously executed by me unless I have stated otherwise below, under\n"Modifications."\n(f) GRANT OF AUTHORITY:\n  To grant your agent some or all of the authority below, either\n      (1) Initial the bracket at each authority you grant, or\n      (2) Write or type the letters for each authority you grant on the\n      blank line at (P), and initial the bracket at (P). If you initial\n      (P), you do not need to initial the other lines.\n        I gran

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