The purpose of this power of attorney is to give the person you designate (your “Agent”) b road powe rs to
handle your prope rty, which may include powers to sell or otherwise di spose of any real or p ersonal
property without advance notice to you or approval by you.
This power of attorney does not impose a duty on your agent to exerci se granted powers, but when
powers are exerci sed, your agent must use d ue care to act for your benefit and in accordance with this
power of attorney.
Your agent may exercise the powers given here throughout your lifetime, even after you become
incapacitated, unless you expressly limit the duration of these po wers or you revoke the se p owers or a
court acting on your behalf terminates your agent’s authority.
Your agent must keep your funds separa te from your agent’s funds.
A court can take away the powers of yo ur agent if it finds your agent is not acting properly.
The powers and duties of an agent un der a power of attorney are explaine d more fully in 20 Pa.C.S.
If there is anything abo ut this form that you do not und erstand, you should ask a lawyer of your own
choosing to explain it to you.
I have read or had explain ed to me this notice and I understand its contents.
Principal’s Name Date
Acknowledgement by Agent
The agent shall have no authority to act as agent under the power of attorney unless the agent has first
executed and affixed to the power of attorney the following a c knowledgem ent.
I, ____________________ ___________ , have read the attached po wer of attorney and am the person
identified as the agent for the principal. I hereby acknowledge that in the absence of a specific provision
to the contrary in the power of attorney or in 20 Pa. C.S. when I act as agent:
I shall exercise the powers for the benefit of the princip al.
I shall keep the asset s of the princip al separate from my assets.
I shall exercise reasonable caution and prudence.
I shall keep a full and accurate reco rd of all action, re ceipts, and disbursements on behalf of the