Section 5-1513. Statutory short form power of attorney

1. The use of 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:
 
                             "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 by executing this Power of Attorney,
  you should provide written  notice  of  the  revocation  to  your  prior
  agent(s)  and  to  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.senate.state.ny.us or www.assembly.state.ny.us.
 
    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, they must act together
  unless you initial the statement below.
 
        (   ) My agents may act SEPARATELY.
  (c) DESIGNATION OF SUCCESSOR AGENT(S): (OPTIONAL)
    If every 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)
  Successor  agents  designated above must act together unless you initial
  the statement below.

        (   ) My successor agents may act SEPARATELY.
  (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 REVOKES any and all prior Powers of  Attorney
  executed   by   me   unless   I   have  stated  otherwise  below,  under
  "Modifications."
    If your are NOT revoking your prior Powers of Attorney, and if you are
  granting the same authority in two or more Powers of Attorney, you  must
  also  indicate  under  "Modifications"  whether  the  agents given these
  powers are to act together or separately.
 
  (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;
        (   ) (J) benefits from governmental programs or civil or military
        service;
        (   ) (K) health  care  billing  and  payment  matters;   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) MODIFICATIONS: (OPTIONAL)
    In  this  section,  you  may  make  additional  provisions,  including
  language to limit or supplement authority granted to your agent.
    However, you cannot use this Modifications section to grant your agent
  authority  to make major gifts or changes to interests in your property.
  If you wish to grant your agent such authority, you  MUST  complete  the
  Statutory Major Gifts Rider.
    (h)  MAJOR  GIFTS  AND  OTHER  TRANSFERS:  STATUTORY MAJOR GIFTS RIDER
  (OPTIONAL)
    In order to authorize  your  agent  to  make  major  gifts  and  other
  transfers  of  your  property,  you must initial the statement below and
  execute a  Statutory  Major  Gifts  Rider  at  the  same  time  as  this
  instrument.  Initialing the statement below by itself does not authorize

  your  agent  to make major gifts and other transfers. The preparation of
  the Statutory Major Gifts Rider should be supervised by a lawyer.
    (      )(SMGR)  I  grant  my  agent  authority to make major gifts and
  other transfers of  my  property,  in  accordance  with  the  terms  and
  conditions  of  the  Statutory  Major  Gifts Rider that supplements this
  Power of Attorney.
 
  (i) DESIGNATION OF MONITOR(S): (OPTIONAL)
    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): (OPTIONAL)
    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,  initial  the  statement  below.  If  you  wish  to  define
  "reasonable compensation", you may do so above, under "Modifications".
    (   )  My  agent(s)  shall  be entitled to reasonable compensation for
  services rendered.
 
  (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) 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  or  all  receipts,  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  manner:  (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  give
  major  gifts  to  yourself  or  anyone  else  unless  the  principal has
  specifically granted you that authority in this Power of Attorney or  in
  a Statutory Major Gifts Rider attached to this 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.
 
  (o) 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.
 
  Agent(s) sign(s) here:==>__________________________________________
 
  (acknowledgment(s))"