Durable General Power of Attorney New York Statutory Short Form

- General Power of Attorney, Statutory Short Form, Durable Form (Rev. 1/1/97)
(amended 9/1/1999 for acknowledgement)
DURABLE GENERAL POWER OF ATTORNEY
NEW YORK STATUTORY SHORT FORM
THE POWERS YOU GRANT BELOW CONTINUE TO BE EFFECTIVE
SHOULD YOU BECOME DISABLED OR INCOMPETENT
(CAUTION: THIS IS AN IMPORTANT DOCUMENT. IT GIVES THE PERSON WHOM YOU DESIGNATE
(YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY DURING YOUR LIFETIME,
WHICH MAY INCLUDE POWERS TO MORTGAGE, SELL OR OTHERWISE DISPOSE OF ANY REAL
OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THESE
POWERS WILL CONTINUE TO EXIST EVEN AFTER YOU BECOME DISABLED OR INCOMPETENT.
THESE POWERS ARE EXPLAINED MORE FULLY IN NEW YORK GENERAL OBLIGATIONS LAW,
ARTICLE 5, TITLE 15, SECTIONS 5-1502A THROUGH 5-1503, WHICH EXPRESSLY PERMIT THE USE
OF ANY OTHER OR DIFFERENT FORM OF POWER OF ATTORNEY.
THIS DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL OR OTHER HEALTH CARE
DECISIONS. YOU MAY EXECUTE A HEALTH CARE PROXY TO DO THIS.
IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK
A LAWYER TO EXPLAIN IT TO YOU.)
THIS is intended to constitute a DURABLE GENERAL POWER OF ATTORNEY pursuant to Article
5, Title 15 of the New York General Obligations Law:
I,       do hereby appoint:
     
(If 1 person is to be appointed agent, insert the name and address of your agent above)
     
(If 2 or more persons are to be appointed agents by you insert their names and addresses above)
my attorney(s)-in-fact TO ACT
(If more than one agent is designated, choose one of the following two choices by putting your initials in
one of the blank spaces to the left of your choice:)
(     ) Each agent may SEPARATELY act.
(     ) All agents must act TOGETHER.
(If neither blank space is initialed, the agents will be required to act TOGETHER)
IN MY NAME, PLACE AND STEAD in any way which I myself could do, if I were personally present, with
respect to the following matters as each of them is defined in Title 15 of Article 5 of the New York General
Obligations Law and to the extent that I am permitted by law to act through an agent:
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