2023 Connecticut General Statutes › Title 1 - Provisions of General Application › Chapter 15c - Connecticut Uniform Power of Attorney Act and Connecticut Uniform Recognition of Substitute Decision-Making Documents Act › Section 1-352. - Power of attorney short form, long form and optional information form.

(a)(1) A document substantially in the form of either the short form, as set forth in subdivision (2) of this subsection, or the long form, as set forth in subdivision (3) of this subsection, may be used to create a statutory power of attorney that has the meaning and effect prescribed in sections 1-350 to 1-353b, inclusive. No provision of sections 1-350 to 1-353b, inclusive, shall be construed to bar the use of any other or different form of power of attorney desired by the parties concerned.
(2) “DURABLE STATUTORY POWER OF ATTORNEY - SHORT FORM
Notice: The powers granted by this document are broad and sweeping. They are defined in the Connecticut Uniform Power of Attorney Act, which expressly permits the use of any other or different form of power of attorney desired by the parties concerned. The grantor of any power of attorney or the agent may make application to a Probate Court for an accounting as provided in subsection (d) of section 45a-175 of the general statutes. This power of attorney does not authorize the agent to make health care decisions for you.
Know All Persons by These Presents, which are intended to constitute a GENERAL POWER OF ATTORNEY pursuant to the Connecticut Uniform Power of Attorney Act:
That I .... (insert name and address of the principal) do hereby appoint .... (insert name and address of the agent, or each agent, if more than one is designated) my agent(s) TO ACT .....
If more than one agent is designated and the principal wishes each agent alone to be able to exercise the power conferred, insert in this blank the word ‘severally'. Failure to make any insertion or the insertion of the word ‘jointly' shall require the agents to act jointly.
First: In my name, place and stead in any way which I myself could do, if I were personally present, with respect to the following matters as each of them is defined in the Connecticut Uniform Power of Attorney Act to the extent that I am permitted by law to act through an agent:
(Strike out and initial in the opposite box any one or more of the subparagraphs as to which the principal does NOT desire to give the agent authority. Such elimination of any one or more of subparagraphs (A) to (M), inclusive, shall automatically constitute an elimination also of subparagraph (N).)
To strike out any subparagraph the principal must draw a line through the text of that subparagraph AND write his initials in the box opposite.
(A)
Real property;
(  )
(B)
Tangible personal property;
(  )
(C)
Stocks and bonds;
(  )
(D)
Commodities and options;
(  )
(E)
Banks and other financial institutions;
(  )
(F)
Operation of entity or business;
(  )
(G)
Insurance and annuities;
(  )
(H)
Estates, trusts and other beneficial interests;
(  )
(I)
Claims and litigation;
(  )
(J)
Personal and family maintenance;
(  )
(K)
Benefits from governmental programs or civil or military service;
(  )
(L)
Retirement plans;
(  )
(M)
Taxes;
(  )
(N)
All other matters;
(  )
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(Special provisions and limitations may be included in the statutory form power of attorney only if they conform to the requirements of the Connecticut Uniform Power of Attorney Act.)
Second: LIMITATION ON AGENT'S AUTHORITY
An agent MAY NOT use my property to benefit the agent or a dependent of the agent unless I have included that authority in any special instructions below.
Third: Hereby ratifying and confirming all that said agent(s) or substitute(s) do or cause to be done.
Fourth: With full and unqualified authority to exercise or delegate any or all of the foregoing powers granted under this power of attorney to any person or persons whom my agent(s) shall select.
Fifth: 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: ___________________________
If my successor agent is unable or unwilling to act for me, I name as my second successor agent:
Name of Successor Agent: ____________________________
Successor Agent's Address: ___________________________
Sixth: DESIGNATION OF CONSERVATOR OF ESTATE (OPTIONAL)
If a conservator of my estate should be appointed, I designate that .... be appointed to serve as conservator of my estate. If .... is unable to serve or cease to serve as conservator of my estate, I designate that .... be appointed to serve as conservator of my estate.
I direct that bond for the conservator of my estate, including any sureties thereon .... be required .... not be required.
Seventh: EFFECTIVE DATE
This power of attorney is effective immediately unless I have stated otherwise in the special instructions.
The execution of this statutory short form power of attorney shall be duly acknowledged by the principal in the manner prescribed for the acknowledgment of a conveyance of real property.
In Witness Whereof I have hereunto signed my name and affixed my seal this .... day of ...., 20...
.... (Signature of Principal) (Seal)
....
Witness
....
Witness
STATE OF
ss:
COUNTY OF
....
Commissioner of the Superior Court
Notary Public
My commission expires: ....”
(3) “DURABLE STATUTORY POWER OF ATTORNEY - LONG FORM
Notice: The powers granted by this document are broad and sweeping. They are defined in the Connecticut Uniform Power of Attorney Act, which expressly permits the use of any other or different form of power of attorney desired by the parties concerned. The grantor of any power of attorney, the agent or such other person or entities as authorized by statute may make application to a Probate Court for an accounting as provided in subsection (d) of section 45a-175 of the general statutes. This power of attorney does not authorize the agent to make health care decisions for you.
Know All Persons by These Presents, which are intended to constitute a GENERAL POWER OF ATTORNEY pursuant to the Connecticut Uniform Power of Attorney Act:
That I .... (insert name and address of the principal) do hereby appoint .... (insert name and address of the agent, or each agent, if more than one is designated) my agent(s) TO ACT .....
If more than one agent is designated and the principal wishes each agent alone to be able to exercise the power conferred, insert in this blank the word ‘severally'. Failure to make any insertion or the insertion of the word ‘jointly' shall require the agents to act jointly.
First: In my name, place and stead in any way which I myself could do, if I were personally present, with respect to the following matters as each of them is defined in the Connecticut Uniform Power of Attorney Act to the extent that I am permitted by law to act through an agent:
(Strike out and initial in the opposite box any one or more of the subparagraphs as to which the principal does NOT desire to give the agent authority. Such elimination of any one or more of subparagraphs (A) to (M), inclusive, shall automatically constitute an elimination also of subparagraph (N).)
To strike out any subparagraph the principal must draw a line through the text of that subparagraph AND write his initials in the box opposite.
(A)
Real property;
(  )
(B)
Tangible personal property;
(  )
(C)
Stocks and bonds;
(  )
(D)
Commodities and options;
(  )
(E)
Banks and other financial institutions;
(  )
(F)
Operation of entity or business;
(  )
(G)
Insurance and annuities;
(  )
(H)
Estates, trusts and other beneficial interests;
(  )
(I)
Claims and litigation;
(  )
(J)
Personal and family maintenance;
(  )
(K)
Benefits from governmental programs or civil or military service;
(  )
(L)
Retirement plans;
(  )
(M)
Taxes;
(  )
(N)
All other matters;
(  )
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(Special provisions and limitations may be included in the statutory form power of attorney only if they conform to the requirements of the Connecticut Uniform Power of Attorney Act.)
OPTIONAL ESTATE PLANNING POWERS
YOU SHOULD SEEK LEGAL ADVICE BEFORE INCLUDING THE FOLLOWING POWERS:
(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.)
My agent MAY NOT do any of the following specific acts UNLESS I HAVE INITIALED the specific authority listed below:
(O)
Create, amend, revoke or terminate an inter vivos trust, provided in the case of a trust established for a disabled person pursuant to 42 USC 1396p (d)(4)(A) or 42 USC 1396p (d)(4)(C), the creation of such trust by an agent shall be only as permitted by federal law;
(  )
(P)
Make a gift, subject to the limitations of the Connecticut Uniform Power of Attorney Act and any special instructions in this power of attorney. Unless otherwise provided in the special instructions, gifts per recipient may not exceed the annual dollar limits of the federal gift tax exclusion under Internal Revenue Code Section 2503(b), or if the principal's spouse agrees to consent to a split gift pursuant to Internal Revenue Code Section 2513, in an amount per recipient not to exceed twice the annual federal gift tax exclusion limit. In addition, an agent must determine that gifts are consistent with the principal's objectives if actually known by the agent and, if unknown, as the agent determines is consistent with the principal's best interest based on all relevant factors;
(  )
(Q)
Create or change rights of survivorship;
(  )
(R)
Create or change a beneficiary designation;
(  )
(S)
Waive the principal's right to be a beneficiary of a joint and survivor annuity, including a survivor benefit under a retirement plan;
(  )
(T)
Exercise fiduciary powers that the principal has authority to delegate;
(  )
(U)
Disclaim or refuse an interest in property, including a power of appointment.
(  )
(V)
Exercise all powers I may have over any digital device, digital asset, user account and electronically stored information, including any user account and digital asset that currently exists or may exist as technology develops, whether the same is in my own name or that I own or lawfully use jointly with any other individual; such powers include, but are not limited to, changing and circumventing my username and password to gain access to such user accounts and information; transferring or withdrawing funds or other digital assets among or from such user accounts; opening new user accounts in my name; all as my agent determines is necessary or advisable. I hereby give my lawful consent and fully authorize my agent to access, manage, control, delete and terminate any electronically stored information and communications of mine to the fullest extent allowable under the federal Electronic Communications Privacy Act of 1986, 18 USC 2510 et seq., as amended from time to time, the Connecticut Revised Uniform Fiduciary Access to Digital Assets Act and any other federal, state or international privacy law or other law and to take any actions I am authorized to take under all applicable terms of service, terms of use, licensing and other account agreements or laws. To the extent a specific reference to any federal, state, local or international law is required in order to give effect to this provision, I specifically provide that my intention is to so reference such law, whether such law is now in existence or comes into existence or is amended after the date of this document.
(  )
(W)
With respect to any intellectual property interests of mine, including, without limitation, copyrights, contracts for payments of royalties and trademarks, act in all ways with respect to such interests as if my agent were the owner thereof, including, without limitation, registering ownership, transferring ownership and recording documents to effectuate or memorialize such transfer, granting and revoking licenses, entering, terminating and enforcing agreements, defending ownership and conferring agency upon professionals to represent my interests before governmental agencies, and in general, to exercise all powers with respect to the intellectual property that I could exercise if present.
(  )
An agent MAY NOT use my property to benefit the agent or a dependent of the agent, except to the extent that I have included such authority elsewhere in this document.
Third: With full and unqualified authority to exercise or delegate any or all of the foregoing powers granted under this power of attorney to any person or persons whom my agent(s) shall select.
Fourth: Hereby ratifying and confirming all that said agent(s) or substitute(s) do or cause to be done.
Fifth: 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: ___________________________
If my successor agent is unable or unwilling to act for me, I name as my second successor agent:
Name of Second Successor Agent: ____________________________
Second Successor Agent's Address: ___________________________
Sixth: DESIGNATION OF CONSERVATOR OF ESTATE (OPTIONAL)
If a conservator of my estate should be appointed, I designate that .... be appointed to serve as conservator of my estate. If .... is unable to serve or cease to serve as conservator of my estate, I designate that .... be appointed to serve as conservator of my estate.
I direct that bond for the conservator of my estate, including any sureties thereon .... be required .... not be required.
Seventh: EFFECTIVE DATE
This power of attorney is effective immediately unless I have stated otherwise in the special instructions.
The execution of this statutory long form power of attorney shall be duly acknowledged by the principal in the manner prescribed for the acknowledgment of a conveyance of real property.
In Witness Whereof I have hereunto signed my name and affixed my seal this .... day of ...., 20...
.... (Signature of Principal) (Seal)
....
Witness
....
Witness
STATE OF
}
ss:
COUNTY OF
On this the .... day of ...., 20.., before me, (name of the principal), signer of the foregoing instrument, personally appeared, and acknowledged the execution of such instrument to be his/her free act and deed.
....
Commissioner of the Superior Court
Notary Public
My commission expires: ....”
(b) A power of attorney is a “statutory form power of attorney”, as this phrase is used in sections 1-350 to 1-353b, inclusive, when it is in writing, has been duly acknowledged by the principal and contains the exact wording of clause First set forth in subsection (a) of this section, except that any one or more of subdivisions (A) to (V) may be stricken out and initialed by the principal, in which case the subdivisions so stricken out and initialed and also subdivision (N) shall be deemed eliminated. A statutory form power of attorney may contain modifications or additions of the types described in sections 1-350 to 1-353b, inclusive.
(c) If more than one agent is designated by the principal, such agents, in the exercise of the powers conferred, shall act jointly unless the principal specifically provides in such statutory short form power of attorney that they are to act severally.
(d) (1) The principal may indicate that a power of attorney duly acknowledged in accordance with this section shall take effect upon the occurrence of a specified contingency, including a date certain or the occurrence of an event, provided that an agent designated by the principal executes a written affidavit that such contingency has occurred.
(2) The principal may indicate the circumstance or date certain upon which the power of attorney shall cease to be effective.
(e) The following optional informational form may be used as part of the Statutory Form or as part of a separate document from the Statutory Form.
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 continues 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 through divorce or annulment, 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 Connecticut Uniform Power of Attorney Act, sections 1-350 to 1-353b, inclusive. If you violate the Connecticut Uniform Power of Attorney Act, sections 1-350 to 1-353b, inclusive, or act outside the authority granted, you may be liable for any damages caused by your violation.
If there is anything about this document or your duties that you do not understand, you should seek legal advice.
(P.A. 15-240, S. 41; P.A. 16-40, S. 3, 9; P.A. 17-91, S. 12.)
History: P.A. 15-240 effective July 1, 2016; P.A. 16-40 changed effective date of P.A. 15-240, S. 41, from July 1, 2016, to October 1, 2016, effective May 27, 2016, and amended Subsec. (a) to substantially revise provisions, including adding references to short form and long form, designating existing provisions as Subdivs. (1) and (3), adding Subdiv. (2) re short form statutory power of attorney and making technical and conforming changes, effective October 1, 2016; P.A. 17-91 amended Subsec. (a) by replacing provision re use of either short form or long form with provision re document substantially in form of either short form or long form in Subdiv. (1), replacing “STATUTORY POWER OF ATTORNEY” with “DURABLE STATUTORY POWER OF ATTORNEY”, replacing reference to Sec. 45a-175(b) with reference to Sec. 45a-175(d) and adding provisions re designation of conservator of estate in Subdivs. (2) and (3), substantially amending provisions re limitation on agent's authority in Subdiv. (2), adding reference to other person or entity authorized by statute, deleting Subpara. (S) re authorizing another person to exercise authority under power of attorney, redesignating Subparas. (T) to (V) as Subparas. (S) to (U), adding Subpara. (V) re digital device, digital asset, user account or electronically stored information, added Subpara. (W) re intellectual property interests, replacing provision re limitation on agent's authority with provision re same and adding provision re authority to exercise powers in Subdiv. (3), and making technical changes, effective July 1, 2017.