New York Laws
Title 15 - Statutory Short Form and Other Powers of Attorney for Financial and Estate Planning
5-1513 - Statutory Short Form Power of Attorney.

(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.
(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:
()(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.
(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:
(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))"