KRS § 457.420 — KY Code / Title XLII / Chapter 457 / Section 457.420
457.420 Statutory form power of attorney
Status: in_force

457.420 Statutory form power of attorney.

A document substantially in the following form may be used to create a statutory form

power of attorney that has the meaning and effect prescribed by this chapter:

KENTUCKY

STATUTORY FORM POWER OF ATTORNEY

IMPORTANT INFORMATION

This power of attorney authorizes another person (your agent) to make decisions

concerning your property for you (the principal). Your agent will be able to make

decisions and act with respect to your property (including your money) whether or not

you are able to act for yourself. The meaning of authority over subjects listed on this form

is explained in the Uniform Power of Attorney Act in KRS Chapter 457.

This power of attorney does not authorize the agent to make health-care decisions for you.

You should select someone you trust to serve as your agent. Unless you specify

otherwise, generally the agent’s authority will continue until you die or revoke the power

of attorney or the agent resigns or is unable to act for you.

Your agent is entitled to reasonable compensation unless you state otherwise in the

Special Instructions.

This form provides for designation of one (1) agent. If you wish to name more than one

(1) agent you may name a coagent in the Special Instructions. Coagents are not required

to act together unless you include that requirement in the Special Instructions.

If your agent is unable or unwilling to act for you, your power of attorney will end unless

you have named a successor agent. You may also name a second successor agent.

This power of attorney becomes effective immediately unless you state otherwise in the

Special Instructions.

If you have questions about the power of attorney or the authority you are granting to your

agent, you should seek legal advice before signing this form.

DESIGNATION OF AGENT

I, ______________________________ ______, name the following person as my

agent:

(Name of Principal)

Name of Agent:

Agent's Address:

Agent's Telephone Number

DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)

If my agent is unable or unwilling to act for me, I name as my successor agent:

Name of Successor Agent:

Successor Agent's Address:

Successor Agent's Telephone Number:

If my successor agent is unwilling or unable to act for me, I name as my second successor

agent:

Name of Second Successor Agent:

Second Successor Agent's Address:

Second Successor Agent's Telephone Number:

GRANT OF GENERAL AUTHORITY

I grant my agent and any successor agent general authority to act for me with respect to

the following subjects as defined in the Uniform Power of Attorney Act in KRS Chapter

457:

(INITIAL each subject you want to include in the agent’s general authority. If you wish

to grant general authority over all of the subjects you may initial "All Preceding Subjects"

instead of initialing each subject.)

(___) Real Property

(___) Tangible Personal Property

(___) Stocks and Bonds

(___) Commodities and Options

(___) Banks and Other Financial Institutions

(___) Operation of Entity or Business

(___) Insurance and Annuities

(___) Estates, Trusts, and Other Beneficial Interests

(___) Claims and Litigation

(___) Personal and Family Maintenance

(___) Benefits from Governmental Programs or Civil or Military Service

(___) Retirement Plans

(___) Taxes

(___) All Preceding Subjects

GRANT OF SPECIFIC AUTHORITY (OPTIONAL)

My agent MAY NOT do any of the following specific acts for me UNLESS I have

INITIALED the specific authority listed below:

(CAUTION: Granting any of the following will give your agent the authority to take

actions that could significantly reduce your property or change how your property is

distributed at your death. INITIAL ONLY the specific authority you WANT to give your

agent.)

(___) Create, amend, revoke, or terminate an inter vivos trust

(___) Make a gift, subject to the limitations of the Uniform Power of Attorney Act in

KRS 457.400 and any special instructions in this power of attorney

(___) Create or change rights of survivorship

(___) Create or change a beneficiary designation

(___) Authorize another person to exercise the authority granted under this power of

attorney

(___) Waive the principal’s right to be a beneficiary of a joint and survivor annuity,

including a survivor benefit under a retirement plan

(___) Exercise fiduciary powers that the principal has authority to delegate

(___) Access the content of electronic communications

LIMITATION ON AGENT’S AUTHORITY

An agent that is not my ancestor, spouse, or descendant MAY NOT use my property to

benefit the agent or a person to whom the agent owes an obligation of support unless I

have included that authority in the Special Instructions.

SPECIAL INSTRUCTIONS (OPTIONAL)

You may give special instructions on the following lines:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________

EFFECTIVE DATE

This power of attorney is effective immediately unless I have stated otherwise in the

Special Instructions.

NOMINATION OF CONSERVATOR OR GUARDIAN (OPTIONAL)

If it becomes necessary for a court to appoint a conservator of my estate or guardian of

my person, I nominate the following person(s) for appointment:

Name of Nominee for conservator of my estate:

Nominee’s Address:

Nominee’s Telephone Number:

Name of Nominee for guardian of my person:

Nominee’s Address:

Nominee’s Telephone Number:

RELIANCE ON THIS POWER OF ATTORNEY

Any person, including my agent, may rely upon the validity of this power of attorney or a

copy of it unless that person knows it has terminated or is invalid.

SIGNATURE AND ACKNOWLEDGMENT

Your Signature Date

Your Name Printed

Your Address

Your Telephone Number

State of ____________________________

County of ___________________________

This document was acknowledged before me on

(Date)

by______________________________________.

(Name of Principal)

____________________________________________ (Seal, if any)

Signature of Notary

My commission expires: ________________________

This document prepared by:

__________________________________________________________________

__________________________________________________________________

IMPORTANT INFORMATION FOR AGENT

Agent’s Duties

When you accept the authority granted under this power of attorney, a special legal

relationship is created between you and the principal. This relationship imposes upon you

legal duties that continue until you resign or the power of attorney is terminated or

revoked. You must:

(1) Do what you know the principal reasonably expects you to do with the principal’s

property or, if you do not know the principal’s expectations, act in the principal’s

best interest;

(2) Act in good faith;

(3) Do nothing beyond the authority granted in this power of attorney; and

(4) Disclose your identity as an agent whenever you act for the principal by writing or

printing the name of the principal and signing your own name as "agent" in the following

manner:

(Principal’s Name) by (Your Signature) as Agent

Unless the Special Instructions in this power of attorney state otherwise, you must also:

(1) Act loyally for the principal’s benefit;

(2) Avoid conflicts that would impair your ability to act in the principal’s best interest;

(3) Act with care, competence, and diligence;

(4) Keep a record of all receipts, disbursements, and transactions made on behalf of the

principal;

(5) Cooperate with any person that has authority to make health-care decisions for the

principal to do what you know the principal reasonably expects or, if you do not

know the principal’s expectations, to act in the principal’s best interest; and

(6) Attempt to preserve the principal’s estate plan if you know the plan and preserving

the plan is consistent with the principal’s best interest.

TERMINATION OF AGENT'S AUTHORITY

You must stop acting on behalf of the principal if you learn of any event that terminates

this power of attorney or your authority under this power of attorney. Events that

terminate a power of attorney or your authority to act under a power of attorney include:

(1) Death of the principal;

(2) The principal’s revocation of the power of attorney or your authority;

(3) The occurrence of a termination event stated in the power of attorney;

(4) The purpose of the power of attorney is fully accomplished; or

(5) If you are married to the principal, a legal action is filed with a court to end your

marriage, or for your legal separation, unless the Special Instructions in this power

of attorney state that such an action will not terminate your authority.

LIABILITY OF AGENT

The meaning of the authority granted to you is defined in the Uniform Power of Attorney

Act in KRS Chapter 457. If you violate the Uniform Power of Attorney Act under KRS

Chapter 457 or act outside the authority granted, you may be liable for any damages

caused by your violation.