Power of Attorney Form for New York State

GENERAL POWER OF ATTORNEY

NEW YORK STATUTORY SHORT FORM

DOCUMENT CONTROL

• Effective Date: [Effective Date]
• Document Version: NY-POA-2024.1
• Jurisdiction & Scope: State of New York, General Obligations Law (GOL) Article 5, Title 15

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OFFICIAL NOTICE & LEGAL DISCLAIMER

CAUTION: This is an important legal document. By signing this document, you do not give up your authority to make your own decisions. Rather, you authorize another person (your agent) to make decisions regarding your property and financial matters for you. This document does not authorize the agent to make health care or medical decisions for you. This document may give the agent broad powers to sell, encumber, clear, and otherwise manage your property without advance notice to you or your approval. You may revoke this Power of Attorney at any time. If you have any questions about this document, you should seek competent legal advice.

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PARTIES & IDENTIFICATION

1. PRINCIPAL (Grantor):

• Full Legal Name: [Principal Full Legal Name]
• Residential Address: [Principal Street Address, City, State, Zip]
• Contact Phone: [Principal Phone Number]
• Email: [Principal Email Address]

2. AGENT (Attorney-in-Fact):

• Full Legal Name: [Agent Full Legal Name]
• Residential Address: [Agent Street Address, City, State, Zip]
• Contact Phone: [Agent Phone Number]
• Email: [Agent Email Address]

3. SUCCESSOR AGENT (Optional Alternate):

• Full Legal Name: [Successor Agent Full Legal Name]
• Residential Address: [Successor Agent Street Address, City, State, Zip]
• Contact Phone: [Successor Agent Phone Number]
• Email: [Successor Agent Email Address]

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OPERATIVE CLAUSES & TERMS

SECTION 1: GRANT OF AUTHORITY

The Principal hereby appoints the Agent specified above as attorney-in-fact for the Principal, with respect to all matters indicated below, pursuant to New York General Obligations Law § 5-1501B. If the primary Agent is unable or unwilling to serve, the Successor Agent is hereby appointed with identical powers.

SECTION 2: POWERS OF THE AGENT

(To grant the Agent any of the following powers, the Principal must initial in the corresponding space. Un-initialed powers are withheld.)

• (____) (A) Real estate transactions: To lease, sell, mortgage, purchase, exchange, and maintain real property.
• (____) (B) Chattel and goods transactions: To buy, sell, exchange, lease, or pledge personal property and tangible assets.
• (____) (C) Bond, share, and commodity transactions: To open, maintain, close, buy, or sell stocks, bonds, mutual funds, and commodities.
• (____) (D) Banking transactions: To open, maintain, and close bank accounts; write checks; deposit funds; and execute financial institution documents.
• (____) (E) Business operating transactions: To control, manage, and operate any business entity owned by the Principal.
• (____) (F) Insurance transactions: To procure, maintain, modify, or surrender insurance policies and pay premiums.
• (____) (G) Estate, trust, and other beneficiary transactions: To act as a beneficiary or trustee in estates, trusts, or other legal structures.
• (____) (H) Claims and litigation: To assert, prosecute, submit to arbitration, settle, and compromise claims and lawsuits.
• (____) (I) Personal and family maintenance: To pay necessary living expenses, housing, taxes, insurance, and medical bills for the Principal and dependents.
• (____) (J) Benefits from governmental programs: To apply for and collect Social Security, Medicare, Medicaid, or other government benefits.
• (____) (K) Retirement benefit transactions: To manage, select payout options, and contribute to retirement accounts and pensions.
• (____) (L) Tax matters: To prepare, sign, file, and contest local, state, and federal tax returns and forms.
• (____) (M) All other matters: To act as the Principal's general financial agent for any and all lawful financial purposes not expressly enumerated above.

SECTION 3: GRANT OF SPECIFIC AUTHORITY (OPTIONAL)

(New York law requires explicit initialing for certain high-risk actions. Initial below only if you wish to authorize your agent to perform these specific acts.)

• (____) Create, amend, revoke, or terminate an inter vivos trust.
• (____) Make a gift, subject to the limitations of NY GOL § 5-1514 and any modifications herein.
• (____) Create or change rights of survivorship.
• (____) Create or change a beneficiary designation.
• (____) Waive the Principal’s right to be a beneficiary of a joint and survivor annuity.
• (____) Exercise fiduciary powers that the Principal has authority to delegate.
• (____) Disclaim or refuse an interest in property, including a power of appointment.

SECTION 4: TERM, DURABILITY, AND REVOCATION

1. Durability: This Power of Attorney is [CHOOSE ONE: $\square$ Durable / $\square$ Non-Durable]. Note: Under New York law, a Power of Attorney is presumed to be durable unless it explicitly states that it is terminated by the incapacity of the Principal.
2. Effective Date: This Power of Attorney shall become effective [CHOOSE ONE: $\square$ Immediately upon execution / $\square$ Upon the occurrence of the following event: [Specify Event]].
3. Revocation: The Principal hereby revokes any prior Powers of Attorney executed regarding the subject matters contained herein, and retains the explicit right to revoke or amend this document at any time.

SECTION 5: COMPENSATION AND REIMBURSEMENT OF AGENT

The Agent [CHOOSE ONE: $\square$ Shall / $\square$ Shall Not] be entitled to reasonable compensation for services rendered pursuant to this document. The Agent [SHALL / SHALL NOT] be entitled to reimbursement for reasonable out-of-pocket expenses incurred on behalf of the Principal.

SECTION 6: MANDatory AGENT OBLIGATIONS

By accepting appointment under this instrument, the Agent agrees to:

1. Act in accordance with the Principal’s reasonable expectations and best interest.
2. Avoid conflicts of interest that impair the Agent’s ability to act impartially.
3. Keep comprehensive records of all receipts, disbursements, and transactions conducted on behalf of the Principal.

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EXECUTION & SIGNATURES BLOCK

PRINCIPAL SIGNATURE AND ACKNOWLEDGMENT

IN WITNESS WHEREOF, the Principal has executed this General Power of Attorney on this [Day] day of [Month], [Year].

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[Principal Full Legal Name], Principal

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WITNESS ATTESTATION

(Note: Under New York law, the signature of the Principal must be witnessed by two (2) adults who are not named as agents or successor agents, in the presence of the Principal and each other.)

Witness 1: Signature: _________________________________________ Date: [Date] Printed Name: [Witness 1 Full Name] Address: [Witness 1 Address]

Witness 2: Signature: _________________________________________ Date: [Date] Printed Name: [Witness 2 Full Name] Address: [Witness 2 Address]

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NOTARY PUBLIC ACKNOWLEDGMENT

State of New York, County of [County Name], ss.:

On the [Day] day of [Month] in the year [Year], before me, the undersigned notary public, personally appeared [Principal Full Legal Name], personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that they executed the same in their capacity, and that by their signature on the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument.

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Notary Public, State of New York My Commission Expires: [Notary Expiration Date] [SEAL]

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AGENT’S ACKNOWLEDGMENT

(Note: Every agent designated in this power of attorney must sign this acknowledgment before acting under the authority granted.)

I, [Agent Full Legal Name], have read the foregoing Power of Attorney and am the person identified as the Agent. I hereby acknowledge that I accept appointment as Agent and agree to:

1. Act according to the Principal’s instructions and in the Principal's best interest;
2. Avoid conflicts that would impair my ability to act;
3. Keep records of transactions conducted on behalf of the Principal.

Signature: _________________________________________ Date: [Date] [Agent Full Legal Name], Agent

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STEP-BY-STEP EXECUTION & ENFORCEMENT GUIDE

1. Review and Verification: Ensure all parties review the document thoroughly. Determine which powers to grant by initialing the specific subsections in Section 2 and Section 3. Do not initial powers that are not intended to be granted.
2. Execution in Presence of Witnesses: The Principal must sign this document in the physical presence of two independent adult witnesses. Neither witness can be designated as an Agent or Successor Agent in this document.
3. Notarization: Following witness attestation, the Principal must appear before a licensed New York Notary Public. The Notary must complete the formal acknowledgment block, confirming the identity of the Principal.
4. Agent Execution (Important): The designated Agent (and Successor Agent, if applicable) must sign the Agent’s Acknowledgment section before exercising any authority granted under this document.
5. Recordkeeping & Registration:
   • Store the original executed document in a safe, accessible location (e.g., a fireproof home safe or attorney vault).
   • Provide certified copies to financial institutions, healthcare proxies, or legal counsel as required to effectuate operations.
   • If the power of attorney will be used for real estate transactions, it must be recorded in the Office of the County Clerk in the county where the real property is located.