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Fill and Sign the Cmo Calificar Para La Cobertura Mdica De Medicaid Y Chip Form

Fill and Sign the Cmo Calificar Para La Cobertura Mdica De Medicaid Y Chip Form

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CARTA PODER GENERAL Yo, ________________________, un ciudadano adulto y residente del Condado de ______________, Estado de ________________________, con domicilio establecido en ______________________________________________ he nombrado, constituido y designado y por este medio, nombro, constituyo y designo a __________________________ como mi auténtico apoderado legal, para que se desempeñe de la siguiente manera, lo cual incluye los propósitos de: 1. Disposición de los bienes. Vender, ceder, transferir, traspasar, intercambiar, traspasar mediante escrituras traslativas de dominio, hipotecar, prendar, arrendar, alquilar, autorizar bajo licencias, transmitir por sucesión o herencia, ceder mediante escritura (derechos sobre los bienes), ceder, negociar o disponer de cualquier otra manera, de cualquiera o de la totalidad de mis propiedades, acciones, bonos, comprobantes de deudas y activos financieros, así como también, de otros bienes personales, sean éstos tangibles, intangibles o posean características de ambos, o de la custodia, posesión, interés o cualquier otro derecho sobre los mismos en una venta pública o privada, en los términos, por la contraprestación y en las condiciones que el citado apoderado considere aconsejables. Asimismo, tiene las facultades de formalizar, acusar recibo de, y otorgar aquellos instrumentos y documentación escrita, cualquiera fuera su especie y naturaleza, que pudieran resultar necesarios, convenientes o apropiados en el territorio. 2. Cobranza de deudas. Exigir, cobrar, recuperar, entablar juicios por, recibir y extender recibos o perdones por todo dinero en efectivo, deudas, dividendos, intereses, regalías, legados, anualidades, demandas, descuentos, ingresos, rentas, ganancias, valores u otros bienes de cualquier clase, que pudieran ser exigibles en el presente o con posterioridad a la formalización de esta carta poder, o que puedan adeudárseme en el presente o con posterioridad a la formalización de esta carta poder, o a los que yo pueda tener derecho actualmente o en el futuro. 3. Endosos. (a) Endosar y negociar para cualquiera y todos los propósitos todos los pagarés, letras de cambio, cheques, giros u otros papeles negociables o no negociables pagaderos a mi persona o extendidos a mi orden; (b) Endosar para su transferencia todos los certificados de acciones, bonos u otros valores; (c) Endosar y cobrar pagarés y bonos de ahorro de los Estados Unidos. 4. Ejecución de certificados del gobierno. Ejecutar certificados de gobierno en mi nombre para Poder general - Página 1 todo y cualquier subsidio, compensación y reintegro que el Gobierno de los Estados Unidos o cualquier dependencia o departamento del mismo debiera pagarme apropiadamente. 5. Depositar dinero y otros bienes. Depositar en nombre de mi apoderado o en el mío propio, o en forma conjunta a nombre de ambos, en cualquier institución bancaria, fondos o bienes y retirar cualquier parte o la totalidad de mis depósitos en cualquier momento, por mí en mi nombre. 6. Pedir préstamos de dinero. Pedir dinero en mi nombre cuando mi citado apoderado lo estime necesario, en los términos que a su criterio parezcan adecuados y perfeccionar aquellos instrumentos que puedan exigirse a tales efectos. 7. Adquisición de bienes. Comprar, recibir, arrendar, aceptar o adquirir de otra manera en mi nombre y por mi cuenta, bienes muebles, inmuebles o mixtos, en los términos, por las contraprestaciones y en las condiciones que dicho apoderado considere apropiadas. 8. Recuperar la posesión de una propiedad. Expulsar, desalojar o relevar arrendatarios u otras personas, y recuperar la posesión de todo bien inmueble, mueble o mixto en el que yo tenga un interés actual o futuro. 9. Controversias judiciales. Instituir, mantener, defender, hacer conciliaciones, arbitrar o disponer de otro modo toda y cualquier acción, juicio, embargo o cualquier otro procedimiento legal para mí o en mi contra. 10. Declaraciones de impuestos. Preparar y formalizar declaraciones de impuestos, lo cual incluye entre otras cosas, las declaraciones del impuesto a las ganancias federal, las declaraciones del impuesto a las ganancias estatal, las declaraciones del impuesto del Seguro Social y la información y ganancias estimadas tanto federales como estatales; ejecutar cualquier reclamo para obtener reembolsos, protestos, solicitudes de rebajas de impuestos, peticiones al Concejo de Apelación Fiscal de los Estados Unidos [United States Board of Tax Appeals] o cualquier otro concejo o tribunal, federal o estatal, aprobaciones y denegaciones de la determinación y valoración de impuestos y aprobaciones y denegaciones, acordando en una posterior determinación y valoración de impuestos que se contemple por el estatuto de limitaciones; recibir, endosar y cobrar cualquier cheque que sirva como cancelación de un reintegro de impuestos; examinar y solicitar y recibir copias de declaraciones de impuestos, informes y otra información del Departamento del Tesoro de los Estados Unidos o cualquier otra autoridad fiscal, ya sea federal o estatal, con relación a cualquiera de las cuestiones anteriores. 11. Automóviles. Ejecutar y remitir a la autoridad y a las personas apropiadas, cada uno y todos los documentos, instrumentos y papeles que sean necesarios para efectuar el correspondiente Poder general - Página 2 registro de cualquier automóvil en el que yo tenga un interés actual o pueda tenerlo en el futuro, o la venta y la transferencia del título de propiedad del mismo, de acuerdo con los requisitos legales, y cobrar y recibir el dinero que se pague como contraprestación de dicha venta y transferencia. ASIMISMO, autorizo a mi apoderado antes citado a formalizar, dar acuse de recibo y otorgar cualquier instrumento solemne o cumplir otras formalidades y realizar todas aquellas diligencias que fueran necesarias para concretar la intención del presente documento, otorgando a dicho apoderado por este medio plenos poderes y facultades para que se desempeñe en, y con relación a, los bienes con el mismo alcance y efectividad que yo habría de dispensar si me hiciera cargo de ello personalmente. SIEMPRE Y CUANDO, no obstante, que todas las transacciones negociadas de acuerdo con la presente carta poder por mí o por mi cuenta se realicen en mi nombre, y que todos los endosos e instrumentos formalizados por el citado apoderado con el propósito de ejercer los poderes antedichos contengan mi nombre, seguido por el de mi apoderado y la designación de "apoderado". Asimismo declaro que todo acto o hecho que mi apoderado realice legalmente de acuerdo con la presente carta poder será vinculante para mí y mis herederos, cesionarios y representantes legales y personales, independientemente de que se hayan hecho antes o después de mi fallecimiento, u otra revocación de esta carta poder, a menos y hasta que mi apoderado haya recibido información confiable o una notificación al respecto. EN FE DE LO CUAL, firmo y sello a los _____ días del mes de ____________, del año 20______. ____________________________________ Firma Testigos: _________________________ ________________________ Nombre Nombre _________________________ ________________________ Domicilio Domicilio _________________________ ________________________ __________________________ Nombre __________________________ Domicilio __________________________ Poder general - Página 3 ESTADO DE ____________________ CONDADO DE __________________ El __________________, ante mí, ______________________ (nombre/cargo del funcionario), compareció personalmente ____________________________, a quien por conocerla personalmente (o por me habérmelo demostrado mediante una evidencia contundente) certifico: que es la persona cuyo nombre obra en la carta poder; que me reconoció haber formalizado el mismo en el desempeño de las facultades en ella investidas; y que mediante su firma en dicho documento, la persona o la entidad a cuyo nombre se desempeñó dicha persona, formalizó la carta poder. En fe de lo cual, estampo mi firma y sello. __________________________________ NOTARIO PÚBLICO Mi comisión vence: ___________________ (Sello) Poder general - Página 4 Versión de la lengua inglesa del documento. * English language version of document. GENERAL POWER OF ATTORNEY I, ________________________, an adult resident citizen of ___________________ County, ______________ (State), residing at ______________________________________________ have made, constituted and appointed, and by these presents do make, constitute and appoint, __________________________ my true and lawful attorney to act as follows, including for the purposes of: 1. Disposition of Property. To sell, assign, transfer, convey, exchange, deed, mortgage, pledge, lease, let, license, demise, remise, quitclaim, bargain or otherwise dispose of any or all of my real estate, stocks, bonds, evidences of indebtedness and other securities and other personal tangible and intangible or mixed property, or any custody, possession, interest or right therein at public or private sale, upon such terms, consideration, and conditions as my said attorney shall deem advisable and to execute, acknowledge and deliver such instruments and writings of whatsoever kind and nature as may be necessary, convenient or proper in the premises. 2. Collection of Debts. To demand, collect, recover, sue for, receive and give receipt or release for any monies, debts, dividends, interests, royalties, legacies, annuities, demands, discounts, income, rents, profits, securities or other property of any sort, now or hereafter due or becoming due to me or to which I may be or hereafter become entitled. 3. Endorsements. (d) To endorse and negotiate for any and all purposes all promissory notes, bills of exchange, checks, drafts or other negotiable or non-negotiable paper payable to me or to my order; (e) To endorse for transfer all certificates of stock, bond or other securities; (f) To endorse and cash United States Savings Bonds and notes. 4. Executing Government Vouchers. To execute vouchers in my behalf for any and all allowances, compensation and reimbursements properly payable to me by the Government of the United States or any agency or department thereof. 5. Depositing Money and Other Property. To deposit in my attorney's or my name, or jointly in both our names, in any banking institution, funds or property, and to withdraw any part or all of my deposits at any time made by me in my behalf. 6. Borrowing Money. To borrow money in my name when deemed necessary to my said attorney upon such terms as to my said attorney appear proper and to execute such General Power of Attorney – Page 1 instruments as may be requisite for such purpose. 7. Acquisition of Property. To buy, receive, lease, accept or otherwise acquire in my name and for my account property, real, personal or mixed, upon such terms, considerations and conditions as my said attorney shall think proper. 8. Recovering Possession of Property. To eject, remove or relieve tenants or other persons from, and recover possession of, any property, real, personal or mixed in which I now or hereafter may have an interest. 9. Litigation. To institute, maintain, defend, compromise, arbitrate or otherwise dispose of, any and all actions, suits, attachments or other legal proceedings for or against me. 10. Tax Returns. To prepare and execute any tax returns, including, but not limited to, Federal income tax returns, State income tax returns, Social Security tax returns, and Federal and State information and estimated returns; to execute any claims for refund, protests, applications for abatement, petitions to the United States Board of Tax Appeals or any other Board or Court, Federal or State, consents and waivers to determination and assessment of taxes and consents and waivers agreeing to a later determination and assessment of taxes than is provided by statute of limitations; to receive and endorse and collect any checks in settlement of any refund of taxes; to examine and to request and receive copies of any tax returns, reports and other information from the United States Treasury Department or any other taxing authority, Federal or State, in connection with any of the foregoing matters. 11. Automobiles. To execute and deliver to the proper persons and authority any and all documents, instruments and papers necessary to effect proper registration of any automobile in which I now or may hereafter have an interest, or the sale thereof and transfer of legal title thereto as required by law, and to collect and receipt for all monies paid in consideration of such sale and transfer. FURTHER, I do authorize my aforesaid attorney to execute, acknowledge and deliver any instrument under seal or otherwise, and to do all things necessary to carry out the intent hereof, hereby granting unto my said attorney full power and authority to act in and concerning the premises as fully and effectually as I may do if personally present. PROVIDED, however, that all business transacted hereunder for me or for my account shall be transacted in my name, and that all endorsements and instruments executed by my said attorney for the purpose of carrying out the foregoing powers shall contain my name, followed by that of my said attorney and the designation "attorney-in-fact". General Power of Attorney – Page 2 I further declare that any act or thing lawfully done hereunder by my said attorney shall be binding on myself and my heirs, legal and personal representatives and assigns, whether the same shall have been done either before or after my death, or other revocation of this instrument, unless and until reliable intelligence or notice thereof shall have been received by my said attorney. IN WITNESS WHEREOF, I have hereunto set my hand and seal this the _____ day of ______________________________, 20______. ____________________________________ Signature Witnesses: _________________________ Name _________________________ Address _________________________ ________________________ Name ________________________ Address ________________________ __________________________ Name __________________________ Address __________________________ STATE OF ____________________ COUNTY OF __________________ On __________________, before me, ______________________ (name/title of officer), personally appeared ____________________________, personally know to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. Witness my hand and official seal. __________________________________ NOTARY PUBLIC My Commission Expires: General Power of Attorney – Page 3 ___________________ (Seal) General Power of Attorney – Page 4

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