Durable Power of Attorney Information Sheet - North Dakota

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DURABLE POWER OF ATTORNEY
1. Creation of Durable Power of Attorney for Retirement System-Related Business
By this document I intend to create a durable power of attorney by appointing the person designated
below to make retirement system-related decisions on my behalf and as allowed by the North Dakota
Century Code. This power is expressly limited to decisions relating to my benefits under the Public
Employee Retirement System and the Highway Patrol Retirement System.
2. Designation of Attorney-in-fact
I, , of ,
(Name of Member or Beneficiary) (Street Address)
City of , County of ,
State of do hereby appoint:
of ,
(Name of Attorney-in-Fact) (Street Address)
City of , County of ,
State of , as my attorney-in-fact.
3. General Statement of Authority Granted
I hereby grant to my attorney-in-fact full power and authority to transact all matters relating to the
North Dakota Public Employees Retirement System (NDPERS) and the Highway Patrol Retirement
System (HPRS). This authority includes, but is not limited to, filing applications, making benefit
elections, designating beneficiaries, changing an address, setting up direct deposit, and endorsing
warrants.
I further grant my attorney-in-fact full power and authority to do and perform every act necessary and
proper to be done in the exercise of any of the foregoing powers as fully as I might do or could do if
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