2023 New York Laws › GOB - General Obligations › Article 5 - Creation, Definition and Enforcement of Contractual Obligations › Title 15 - Statutory Short Form and Other Powers of Attorney for Financial and Estate Planning › 5-1513 - Statutory Short Form Power of Attorney.

§ 5-1513.  Statutory  short  form  power  of  attorney. The use of the
following form, or one which substantially  conforms  to  the  following
form,  in the creation of a power of attorney is lawful, and, when used,
and executed in accordance with subdivision one of  section  5-1501B  of
this  title,  it  shall  be construed as a statutory short form power of
attorney in accordance with  the  provisions  of  this  title;  provided
however,  that any section indicated as "Optional" which is not used may
be omitted and replaced by the words "Intentionally Omitted":
"POWER OF ATTORNEY NEW YORK STATUTORY SHORT FORM
(a) CAUTION TO THE PRINCIPAL: Your Power of Attorney is  an  important
document.  As the "principal," you give the person whom you choose (your
"agent") authority to spend your money  and  sell  or  dispose  of  your
property  during your lifetime without telling you. You do not lose your
authority  to  act  even  though  you  have  given  your  agent  similar
authority.
When your agent exercises this authority, he or she must act according
to  any  instructions  you have provided or, where there are no specific
instructions, in your best  interest.  "Important  Information  for  the
Agent"   at   the   end   of   this   document  describes  your  agent's
responsibilities.
Your agent can act on your behalf only  after  signing  the  Power  of
Attorney before a notary public.
You  can  request  information from your agent at any time. If you are
revoking a prior Power of Attorney, you should provide written notice of
the revocation to your prior agent(s) and to any third parties  who  may
have  acted  upon  it,  including  the financial institutions where your
accounts are located.
You can revoke or terminate your Power of Attorney at any time for any
reason as long as you are of sound mind. If you are no longer  of  sound
mind, a court can remove an agent for acting improperly.
Your  agent cannot make health care decisions for you. You may execute
a "Health Care Proxy" to do this.
The law governing Powers of Attorney is  contained  in  the  New  York
General Obligations Law, Article 5, Title 15. This law is available at a
law  library,  or  online  through the New York State Senate or Assembly
websites, www.nysenate.gov or www.nyassembly.gov.
If there is anything about this document that you do  not  understand,
you should ask a lawyer of your own choosing to explain it to you.
(b) DESIGNATION OF AGENT(S):
I, _______________________________________________, hereby appoint:
name and address of principal
_____________________________________________________as my agent(s)
name(s) and address(es) of agent(s)
If  you designate more than one agent above and you do not initial the
statement below, they must act together.
) My agents may act SEPARATELY.
(c) DESIGNATION OF SUCCESSOR AGENT(S): (OPTIONAL)
If any agent designated above is  unable  or  unwilling  to  serve,  I
appoint as my successor agent(s):
_______________________________________________________________
name(s) and address(es) of successor agent(s)
If you do not initial the statement below, successor agents designated
above must act together.    ) My successor agents may act SEPARATELY.
You  may provide for specific succession rules in this section. Insert
specific succession provisions here:

(d) This POWER OF ATTORNEY  shall  not  be  affected  by  my  subsequent
incapacity unless I have stated otherwise below, under "Modifications".
(e)  This  POWER  OF  ATTORNEY  DOES  NOT  REVOKE any Powers of Attorney
previously executed by me unless I have stated  otherwise  below,  under
"Modifications."
(f) GRANT OF AUTHORITY:
To grant your agent some or all of the authority below, either
(1) Initial the bracket at each authority you grant, or
(2)  Write or type the letters for each authority you grant on the
blank line at (P), and initial the bracket at (P). If you initial
(P), you do not need to initial the other lines.
I grant authority to my agent(s) with respect to  the  following
subjects as defined in sections 5-1502A through 5-1502N of the New
York General Obligations Law:
) (A) real estate transactions;    ) (B) chattel and goods transactions;    ) (C) bond, share, and commodity transactions;    ) (D) banking transactions;    ) (E) business operating transactions;    ) (F) insurance transactions;    ) (G) estate transactions;    ) (H) claims and litigation;    )  (I)  personal and family maintenance. If you grant your agent
this authority, it will allow the agent to  make  gifts  that  you
customarily  have  made  to  individuals, including the agent, and
charitable organizations. The total amount of all  such  gifts  in
any one calendar year cannot exceed five thousand dollars;    )  (J)  benefits from governmental programs or civil or military
service;
()(K) financial matters related to health care; records, reports,
and statements;
()(L) retirement benefit transactions;
()(M) tax matters;
()(N) all other matters;
()(O) full and unqualified authority to my agent(s)  to  delegate
any  or  all of the foregoing powers to any person or persons whom
my agent(s) select;
()(P) EACH  of  the   matters   identified   by   the   following
letters______.
You need not initial the other lines if you initial line (P).
(g) CERTAIN GIFT TRANSACTIONS: (OPTIONAL)
In  order to authorize your agent to make gifts in excess of an annual
total of $5,000 for all gifts described in (I) of the grant of authority
section of this document (under personal and family maintenance), and/or
to make changes to interest in your property, you must  expressly  grant
that  authorization  in  the Modifications section below. If you wish to
authorize your agent to make gifts  to  himself  or  herself,  you  must
expressly  grant  such authorization in the Modifications section below.
Granting such authority to your agent gives your agent the authority  to
take  actions  which  could  significantly  reduce  your property and/or
change how your property is distributed at your death.  Your  choice  to
grant such authority should be discussed with a lawyer.
)  I  grant  my agent authority to make gifts in accordance with the
terms and conditions of the Modifications that supplement this Statutory
Power of Attorney.
(h) MODIFICATIONS: (OPTIONAL)
In this section, you may make additional  provisions,  including,  but
not  limited  to,  language  to limit or supplement authority granted to

your agent, language to grant your agent the specific authority to  make
gifts  to  himself  or  herself, and/or language to grant your agent the
specific authority to make other gift  transactions  and/or  changes  to
interests in your property. Your agent is entitled to be reimbursed from
your  assets  for  reasonable  expenses incurred on your behalf. In this
section, you may make  additional  provisions  if  you  ALSO  wish  your
agent(s)  to  be  compensated  from your assets for services rendered on
your behalf, and you may define "reasonable compensation."
(i) DESIGNATION OF MONITOR(S): (OPTIONAL)
If you wish to appoint monitor(s), initial and  fill  in  the  section
below:
)  I  wish to designate ______________________, whose address(es) is
(are)  ____________________________________________________________,  as
monitor(s). Upon the request of the monitor(s), my agent(s) must provide
the  monitor(s) with a copy of the power of attorney and a record of all
transactions done or made on my behalf. Third parties holding records of
such transactions shall provide  the  records  to  the  monitor(s)  upon
request.
(j) COMPENSATION OF AGENT(S):
Your  agent  is  entitled  to  be  reimbursed  from  your  assets  for
reasonable expenses incurred on your  behalf.  If  you  ALSO  wish  your
agent(s)  to  be  compensated  from your assets for services rendered on
your behalf, and/or you wish to define  "reasonable  compensation",  you
may do so above, under "Modifications".
(k)  ACCEPTANCE  BY  THIRD PARTIES: I agree to indemnify the third party
for any claims that  may  arise  against  the  third  party  because  of
reliance on this Power of Attorney. I understand that any termination of
this Power of Attorney, whether the result of my revocation of the Power
of Attorney or otherwise, is not effective as to a third party until the
third party has actual notice or knowledge of the termination.
(l)  TERMINATION:  This Power of Attorney continues until I revoke it or
it is terminated by my death or other event described in section  5-1511
of the General Obligations Law.
Section  5-1511 of the General Obligations Law describes the manner in
which you may revoke your  Power  of  Attorney,  and  the  events  which
terminate the Power of Attorney.
(m)  SIGNATURE  AND  ACKNOWLEDGMENT:  In Witness Whereof I have hereunto
signed my name on ___________,20___.
PRINCIPAL signs here: ==>__________________________________________
(acknowledgment)
(n) SIGNATURES OF WITNESSES:
By signing as a witness, I acknowledge that the principal  signed  the
Power  of  Attorney  in  my  presence  and  in the presence of the other
witness, or that the principal acknowledged to me that  the  principal's
signature  was  affixed by him or her or at his or her direction. I also
acknowledge that the principal has stated that this  Power  of  Attorney
reflects his or her wishes and that he or she has signed it voluntarily.
I  am  not  named  herein  as  an agent or as a permissible recipient of
gifts.
 
_____________________________________________________________
Signature of Witness 1                        Signature of Witness 2
____________________________________________________________
Date                                          Date
____________________________________________________________
Print name                                    Print name
____________________________________________________________
Address                                       Address

____________________________________________________________
City, State, Zip Code                           City, State, Zip Code
(o) IMPORTANT INFORMATION FOR THE AGENT:
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  on you legal responsibilities that continue
until you resign or the Power of Attorney is terminated or revoked.  You
must:
(1)  act  according  to any instructions from the principal, or, where
there are no instructions, in the principal's best interest;
(2) avoid conflicts that would impair  your  ability  to  act  in  the
principal's best interest;
(3)  keep  the  principal's  property  separate  and distinct from any
assets you own or control, unless otherwise permitted by law;
(4) keep a record of all transactions conducted for the  principal  or
keep  all  receipts  of  payments  and  transactions  conducted  for the
principal; and
(5) disclose your identity as  an  agent  whenever  you  act  for  the
principal  by  writing or printing the principal's name and signing your
own name as "agent" in either of  the  following  manners:  (Principal's
Name)  by  (Your  Signature)  as Agent, or (your signature) as Agent for
(Principal's Name).
You may not use the principal's assets to benefit yourself  or  anyone
else  or  make gifts to yourself or anyone else unless the principal has
specifically granted you that authority in the modifications section  of
this  document  or  a  Non-Statutory Power of Attorney. If you have that
authority, you must act according to any instructions of  the  principal
or,  where  there  are  no  such  instructions,  in the principal's best
interest. You may resign by giving written notice to the  principal  and
to  any co-agent, successor agent, monitor if one has been named in this
document, or the principal's guardian if  one  has  been  appointed.  If
there  is anything about this document or your responsibilities that you
do not understand, you should seek legal advice.
Liability of agent:
The meaning of the authority given to you is  defined  in  New  York's
General  Obligations  Law,  Article 5, Title 15. If it is found that you
have violated the law or acted outside the authority granted to  you  in
the  Power  of  Attorney,  you  may  be  liable  under  the law for your
violation.
(p) AGENT'S SIGNATURE AND ACKNOWLEDGMENT OF APPOINTMENT:
It is not required that the principal and the  agent(s)  sign  at  the
same time, nor that multiple agents sign at the same time.
I/we,   ___________________________________________,   have   read   the
foregoing Power of  Attorney.  I  am/we  are  the  person(s)  identified
therein as agent(s) for the principal named therein.
I/we acknowledge my/our legal responsibilities.
In  Witness  Whereof  I have hereunto signed my name on ________________
20_____.
Agent(s) sign(s) here:==>__________________________________________
(acknowledgment(s))
(q) SUCCESSOR AGENT'S SIGNATURE AND ACKNOWLEDGMENT OF APPOINTMENT:
It is not required that the principal and the SUCCESSOR  agent(s),  if
any,  sign  at the same time, nor that multiple SUCCESSOR agents sign at
the same time. Furthermore, successor agents can not use this  power  of
attorney unless the agent(s) designated above is/are unable or unwilling
to serve.

I/we,   ___________________________________________,   have   read   the
foregoing Power of  Attorney.  I  am/we  are  the  person(s)  identified
therein as SUCCESSOR agent(s) for the principal named therein.
In  Witness  Whereof  I have hereunto signed my name on ________________
20_____.
Successor Agent(s) sign(s) here:==>______________________________________
(acknowledgment(s))"