Fill and Sign the Execute a Separate Document for that Purpose Form

General Durable Power of Attorney Page 1 of 9 GENERAL DURABLE POWER OF ATTORNEY THE POWERS YOU GRANT BELOW ARE EFFECTIVE EVEN IF 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 EXIST EVEN IF YOU BECOME DISABLED OR INCOMPETENT. THIS DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL OR OTHER HEALTH CARE DECISIONS FOR YOU. YOU MAY EXECUTE A SEPARATE DOCUMENT FOR THAT PURPOSE. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER TO EXPLAIN IT TO YOU. KNOWN BY ALL PERSONS PRESENT, THAT: I, __________________________________ (name), _____________________________ (address), “Principal”, execute this Durable Power of Attorney and do hereby make, constitute and appoint: ___________________________________ (name), ___________________________ (address), "Agent" or "Attorney-in-Fact", as my attorney-in-fact TO ACT IN MY NAME, PLACE AND STEAD in any way which I myself could do as if I were personally present and to the extent that I am permitted by law to act through an agent, pursuant to the following provisions: 1. EFFECTIVENESS OF POWER OF ATTORNEY (initial applicable section): This instrument is to be construed and interpreted as a general durable power of attorney effective only upon my disability, incompetency or incapacity. It is my int
I have the sole responsibility, on written request, to determine whether I want to execute my health care power of attorney instead of my durable power of attorney. 2. Limitation on power (initial applicable section): in the event one or more of the conditions specified in the condition statement are never satisfied, this instrument will automatically expire 10 years after the occurrence of the condition stated. If one or more conditions in the condition statement are satisfied, this instrument will automatically expire 5 years after my disability, incapacity or incapacity has been established. 3. Expiration (final date of expiration): unless (name of the individual or the individual's representative), (agency), (organization), (business, business agency), (collective, partnership) objects, this durable power of attorney is to expire 5 years after its effective date, if a condition is satisfied or if a condition is not satisfied, or 2 years after the occurrence of the disability, incapacity or incapacity indicated on the condition statement. If 2 conditions in the condition statement are not determined to be satisfied as provided herein, this power of attorney will automatically expire 10 years after the date of the condition stated, whichever period of time is shorter. 4. Assignment of powers and responsibility (initial applicable section): all powers granted herein are granted in the name, place and stead of the individual named as the authorized person by me with power of attorney. The power of attorney and all attachments contained in this durable power of attorney will be revocable in the event that: a person named as an authorized agent or (otherwise than because of a limitation of time) the authorized agent, does not perform the power or any of the duties or obligations under the power. Such person may seek to terminate this power of attorney at any time. A successor authorized agent for (name of individual or representative) has power of attorney from (designated by the individual named in power of attorney) and should execute the durable power of attorney. 5. Severability (initial applicable scene of severability): if any provision or the application thereof to any person or circumstance is held invalid, unconstitutional, invalid, or in any cases unenforceable in whole or in part or if any sentence, condition, or provision thereof is declared to be void, unenforceable or illegal by any court of competent jurisdiction, such invalidity, unenforceability or invalidity or the invalidity or unenforceability of any sentence, condition or provision as to any person.