STATE OF
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", part 7 of article
14 of title 15, Colorado Revised Statutes. 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 agent. If you wish to name more
than one agent you may name a co-agent in the special instructions. Co-agents 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 of principal) name the following person
as my agent:
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 unable or unwilling 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", part 7 of article 14 of title 15, Colorado Revised
Statutes: (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"
set forth in section 15-14-740, Colorado Revised Statutes, 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
(___)
Disclaim, refuse, or release an interest in property or a power of appointment
(___)
Exercise a power of appointment other than: (1) The exercise of a general power
of appointment for the benefit of the principal which may, if the subject of
estates, trusts, and other beneficial interests is authorized above, be
exercised as provided under the subject of estates, trusts, and other
beneficial interests; or (2) The exercise of a general power of appointment for
the benefit of persons other than the principal which may, if the making of a
gift is specifically authorized above, be exercised under the specific
authorization to make gifts
(___)
Exercise powers, rights, or authority as a partner, member, or manager of a
partnership, limited liability company, or other entity that the principal may
exercise on behalf of the entity and has authority to delegate excluding the
exercise of such powers, rights, and authority with respect to an entity owned
solely by the principal which may, if operation of entity or business is
authorized above, be exercised as provided under the subject of operation of
the entity or business
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 this ___________ day of ________________,
_______ (date) by______________________________________________________________________.
(Name of principal)
______________________________________
(Seal, if
any)
Signature
of notary
My
commission expires: ________________________
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", part 7 of article 14 of title 15, Colorado Revised
Statutes. If you violate the "Uniform Power of Attorney Act", part 7
of article 14 of title 15, Colorado Revised Statutes, 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.
AGENT'S CERTIFICATION AS
TO THE VALIDITY OF POWER OF ATTORNEY AND AGENT'S AUTHORITY
State
of _____________________________
County
of ___________________________
I,
____________________________________ (Name of agent), certify under penalty of
perjury that ______________________________ (Name of principal) granted me
authority as an agent or successor agent in a power of attorney dated
________________________.
I
further certify that to my knowledge:
(1)
The principal is alive and has not revoked the power of attorney or my
authority to act under the power of attorney and the power of attorney and my
authority to act under the power of attorney have not terminated;
(2)
If the power of attorney was drafted to become effective upon the happening of
an event or contingency, the event or contingency has occurred;
(3)
If I was named as a successor agent, the prior agent is no longer able or
willing to serve; and
(4)__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
(Insert other relevant statements)
Signature
and acknowledgment
________________________________________________________
____________________
Agent’s
Signature Date
________________________________________________________
Agent’s
name printed
________________________________________________________
________________________________________________________
Agent’s
address
________________________________________________________
Agent’s
telephone number
This
document was acknowledged before me on this ___________ day of
________________, _______ (date) by______________________________________________________________________.
(Name of principal)
______________________________________
(Seal, if
any)
Signature
of notary
My
commission expires: ________________________
This
document prepared by:
__________________________________________________________________________________________________________________________________________________________________________________