Uniform Statutory Form Power of Attorney
(California Probate Code Section 4401)
NOTICE: The powers granted by this document are broad and sweeping. They are explained in the Uni-
form Statutory Form Power of Attorney Act (California Probate Code sections 4400-4465). If you have any
questions about these powers, obtain competent legal advice. This document does not authorize anyone to
make medical and other health-care decisions for you. You may revoke this power of attorney if you later
wish to do so.
(your name and address)
(name and address of the person appointed, or of each person appointed if you want to designate more than one)
as my agent (attorney-in-fact) to act for me in any lawful way with respect to the
following initialed subjects:
____ (A) Real property transactions.
____ (B) Tangible personal property transactions.
____ (C) Stock and bond transactions.
____ (D) Commodity and option transactions.
____ (E) Banking and other nancial institution transactions.
____ (F) Business operating transactions.
____ (G) Insurance and annuity transactions.
____ (H) Estate, trust, and other beneciary transactions.
____ (I) Claims and litigation.
____ (J) Personal and family maintenance.
____ (K) Benets from social secuirty, medicare, medicaid, or other governmental
programs, or civil or military service.
____ (L) Retirement plan transactions.
____ (M) Tax matters.
____ (N) ALL OF THE POWERS LISTED ABOVE.
You need not initial any other lines if you initial line (N).
To grant all of the following powers, initial the line in front of (N) and ignore the lines in front of the other
To grant one or more, but fewer than all, of the following powers, initial the line in front of each of the
powers you are granting.
To withhold a power, do not initial the line in front of it. You may, but need not, cross out each power with-
(Continued on Reverse)