Prepared by: _______________________________
Address tax statement to: _______________________________
_______________________________
GENERAL DURABLE POWER OF ATTORNEY
THE POWERS YOU GRANT BELOW ARE EFFECTIVE ONLY UPON YOUR
DISABILITY AND WILL CONTINUE EVEN IF YOU BECOME DISABLED OR
INCOMPETENT.
THIS POWER OF ATTORNEY AUTHORIZES ANOTHER PERSON (YOUR AGENT)
TO MAKE DECISIONS CONCERNING YOUR PROPERY FOR YOU (THE
PRINCIPAL). YOUR AGENT WILL BE ABLE TO MAKE DECISIONS AND ACT WITH
RESPECT TO YOUR PROPERTY (INCLUDING BUT NOT LIMITED TO YOUR
MONEY) WHETHER OR NOT YOU ARE ABLE TO ACT FOR YOURSELF. THE
MEANING OF AUTHORITY OVER SUBJECTS LISTED ON THIS FORM IS
EXPLAINED IN THE IOWA UNIFORM POWER OF ATTORNEY ACT, IOWA CODE
CHAPTER 633B.
THESE POWERS BECOME EFFECTIVE ONLY UPON DISABILITY AND WILL NOT
EXTINGUISH DUE TO YOUR DISABILITY. THIS DOCUMENT DOES NOT
AUTHORIZE ANYONE TO MAKE MEDICAL OR OTHER HEALTH CARE DECISIONS
FOR YOU.
YOU SHOULD SELECT SOMEONE YOU TRUST TO SERVE AS YOUR AGENT.
UNLESS YOU SPECIFY OTHERWISE, GENERALLY THE AGENT’S AUTHORITY
WILL CONTINUE UNTIL YOU DIE OR REVOKE THE POWER OF ATTORNEY OR
THE AGENT RESIGNS OR IS UNABLE TO ACT FOR YOU.
YOUR AGENT IS NOT ENTITLED TO COMPENSATION UNLESS YOU STATE
OTHERWISE IN THE OPTIONAL SPECIAL INSTRUCTIONS.
THIS FORM PROVIDES FOR DESIGNATION OF ONE AGENT. IF YOU WISH TO
NAME MORE THAN ONE AGENT, YOU MAY NAME A CO-AGENT IN THE
OPTIONAL SPECIAL INSTRUCTIONS. CO-AGENTS MUST ACT BY MAJORITY
RULE UNLESS YOU PROVIDE OTHERWISE IN THE OPTIONAL SPECIAL
INSTRUCTIONS.
IF YOUR AGENT IS UNABLE OR UNWILLING TO ACT FOR YOU, YOUR POWER
OF ATTORNEY WILL END UNLESS YOU HAVE NAMED A SUCCESSOR AGENT.
YOU MAY ALSO NAME A SECOND SUCCESSOR AGENT..
IF YOU HAVE QUESTIONS ABOUT THIS POWER OF ATTORNEY OR THE
AUTHORITY YOU ARE GRANTING TO YOUR AGENT, YOU SHOULD SEEK LEGAL
ADVICE BEFORE SIGNING THIS FORM.
KNOWN BY ALL PERSONS PRESENT, THAT:I, _____________________________________ (complete Name of Principal), whose
address is ______________________________________________________ (Street Address,
City, State, Zip Code) “Principal”, execute this General Durable Power of Attorney and do
hereby make, constitute and appoint: ________________________________________ (Full
Name of Agent) , whose address is ________________________________________________
(Street Address, City, State, Zip Code) "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 intent tha t the
authority conferred herein upon my Agent shall be exercisable only upon my subsequent
disability, incompetency or incapacity. No person who may act in reliance upon the
authority granted to my Agent herein shall incur any liability to me or my estate as a result of
permitting my Agent to exercise any such power.
2. GRANT OF POWERS: I grant to my Agent full power and authorization to do everything
necessary in exercising any of the powers herein granted by this power of attorney as fully as
I might or could do if personally present. My agent shall have full power of substitution or
revocation. I hereby ratify and confirm all that my Agent lawfully does or causes to be done
by virtue of this power of attorney and the powers herein granted. My Agent shall have the
power to exercise or perform any act, power, duty, right or obligation whatsoever that I now
have or may hereinafter acquire, relating to any person, matter, transaction or property, re al
or personal, tangible or intangible, now owned or hereafter acquired by me, including,
without limitation, the following specifically enumerated powers:
(a) Powers of Collection and Payment:
(1) To forgive, request, demand, sue for, recover, collect, receive and hold all sums of money, accounts, annuities, bequests, bonds, certificates of deposit, checks,
commercial paper, debts, deposits, devises, dividends, drafts, dues, insurance,
interests, legacies, notes, pension, profit sharing, retirement, social security, stock
certificates and other contractual benefits and proceeds, all documents of title , all
property, real or personal, intangible or tangible, and property rights and demands
whatsoever, liquidated or unliquidated, now or hereafter owned by, or due, owing,
payable or belonging to, me or in which I have or may hereafter acquire an interest.
(2) To have, use, and take all lawful means and equitable and legal remedies a nd
proceedings in my name for the collection and recovery thereof, and to adjust, sell,
compromise, and agree for the same, and to execute and deliver for me, on my behal f,
and in my name, all endorsements, releases receipts, or other sufficient discharges for
the same.
(b) Property Matters:
(1) To acquire, purchase, exchange and sell, or grant options to sell, mortgage, pledge, lease, sell and convey real or personal property, tangible or intangible, or interests
therein, on such terms and conditions as my Agent shall deem proper, with full
authority to sign, endorse, execute and deliver any sales agreement, deed, bill of sale
and all other instruments or documents pertaining to the sale of any of my real or
personal property; and to enter into bonds, contracts, mortgages and deeds connected
therewith.
(2) To sell, assign, transfer, convey, exchange, deed, mortgage, pledge, lease, let, lice nse,
demise, remise, quitclaim, bargain or otherwise dispose of any or all of my real esta te,
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.
(c) Management Powers: To maintain, repair, improve, invest, manage, insure, rent, lease ,
encumber, and in any manner deal with any real or personal property, tangible or
intangible, or any interest therein that I now own or may hereafter acquire in my name
and for my benefit, upon such terms and conditions as my Agent shall deem proper;
(d) Banking Powers: To make, receive and endorse checks and drafts, deposit and withdraw
funds, acquire and redeem certificates of deposit, in banks, savings and loan associations,
and other institutions, execute or release such deeds of trust or other security agreements
as may be necessary or proper in the exercise of the rights and powers herein granted;
(e) Business Interests: To conduct or participate in any lawful business of whatever nature
for me and in my name; to execute partnership agreements and amendments thereto; t o
incorporate, reorganize, merge, consolidate, recapitalize, sell, liquidate or dissolve a ny
business; to elect or employ officers, directors and agents; to carry out the provisions of
any agreement for the sale of any business interest or the stock therein; and to exerc ise
voting rights with respect to stock, either in person or by proxy, and to exercise stock
options;
(f) Safe Deposit Boxes: To have access at any time or times to any safe deposit box rented
by me, wheresoever located, and to remove all or part of the contents thereof, and to
surrender or relinquish said safe deposit box, and any institution in which any such safe
deposit box may be located shall not incur any liability to me or my estate as a result of
permitting my Agent to exercise this power;
(g) Power to Hold Property and Make Investments: The power to hold or acquire any
property, real or personal, or securities, regardless of whether such property or securities
are a so-called “Legal” investment, where such course is, in the said Agent’s opini on, for
my best interest;
(h) Power to Borrow: To borrow any sum or sums of money on such terms (including the
power to borrow against the cash surrender value of any life insurance policy issued on
my life), and with such security, whether real or personal property, as my Agent may
think fit, and for that purpose to execute all promissory notes, bonds, mortgages, deeds of
trust, security agreements, and other instruments which may be necessary or proper;
(i) Disclaimer: To exercise or release powers of appointment in whole or in part and to
disclaim or renounce in whole or in part any interest that I might otherwise have as a joint
owner, beneficiary, heir or otherwise and in exercising such discretion, my Agent may
take into account such matters as shall include but shall not be limited to any reduction in
estate or inheritance taxes on my estate, and the effect of such renunciation or disclaimer
upon persons interested in my estate and persons who would receive the renounced or
disclaimed property;
(j) Trusts: To transfer, assign and convey any property or interest in property, the legal or
equitable title to which is in my name, to any trust of which I am the primary beneficiary
during my lifetime and under the terms of which I expressly have the power to amend or
revoke such trust, and to exercise any right of withdrawal of income and/or principal
which I may have pursuant to the terms and conditions of such trust, whether such trust
was created before or after the execution of this power of attorney;
(k) Power to Change Beneficiaries on Any Insurance Policies on my Life: To change the
beneficiaries on any insurance policies on my life; provided, however, that neither such
right and power, nor any other rights and powers, shall be exercisable with respect to any
policies of life insurance which may at any time be owned by me on the life of my Agent
herein named.
(l) 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.
(m) 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.
(n) 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.
(o) Litigation. To institute, maintain, defend, compromise, arbitrate or otherwise di spose of,
any and all actions, suits, attachments or other legal proceedings for or against me.
(p) 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, a nd
Federal and State information and estimated returns; to execute any claims for re fund,
protests, applications for abatement, petitions to the United States Board of Tax Appea ls
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 re quest 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.
(q) 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 a nd
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.
3. MISCELLANEOUS: I grant to the Agent named herein the following additional powers of
authority:
(a) In the event any agent named herein should be of the opinion at any time that she or he
does not have the expertise to manage all or any part of my assets, I grant to said Agent
the right and power to delegate the management powers hereinabove granted over all or
any part of my assets to any person(s) or firm(s), and to enter into any management or
agency agreements with said person(s) or firm(s), pertaining thereto, with the right on the
part of the Agent named herein to revoke and cancel any such agreement at any time
upon ninety (90) days’ written notice to said person(s) or firm(s).
(b) I grant full and absolute authority to the Agent named herein, on a noncumulative, yearl y
basis, to make gifts to my children, in trust or otherwise, as well as to their spouses, and
to their children, in trust or otherwise, with the amount of gifts to each such person e ach
year not to exceed that amount which is excludable from the total amount of gifts made
during such year under Section 2503(b) Internal Revenue Code of 1986, as amended
from time to time.
(c) I further authorize and empower the Agent named herein to use and apply so much of the income and principal of the assets comprising my estate as may be necessary or desira ble,
in the sole discretion of said Agent, for my maintenance and support. Any provision
herein to the contrary notwithstanding, the Agent shall have no power or authority to use
or apply the principal to discharge any legal obligation that the agent or any other pe rson
may have to support me or any dependent or beneficiary or mine, except to the extent t hat
there are no assets reasonably available to the person having the obligation of support to
pay the same.
(d) I further authorize and empower my Agent to engage, employ and dismiss any agents, clerks, servants, attorneys-at-law, accountants, investment advisors, custodians, or other
persons in and about the performance of these presents as my Agent shall think fit.
Any decisions made by the said Agent with respect to the matters set forth hereinabove in
sections 3(b), 3(c), and 3(d) shall be final, binding and conclusive upon all of the
beneficiaries of my estate, and said Agent shall be released and discharged of and from all
liability for any such decisions that she or he may make in good faith with respect thereto.
GRANT OF SPECIFIC AUTHORITY (OPTIONAL)
My agent MAY NOT do any of the following specific acts for me UNLESS I have
INITIALED the specific authority listed below:
(CAUTION: Granting any of the following will give your agent the authority to take
actions that could significantly reduce your property or change how your property is
distributed at your death. INITIAL ONLY the specific authority you WANT to give your
agent.)
(_____) Create, amend, revoke, or terminate an inter vivos trust
(_____) Make a gift, subject to the limitations of the Iowa Uniform Power of Attorney Act
and any special instructions in this power of attorney
(_____) Create or change rights of survivorship
(_____) Create or change a beneficiary designation
(_____) Authorize another person to exercise the authority granted under this power of
attorney
(_____) Waive the principal’s right to be a beneficiary of a joint and survivor annuity,
including a survivor benefit under a retirement plan
(_____) Exercise fiduciary powers that the principal has authority to delegate
(_____) Disclaim or refuse an interest in property, including a power of appointment]LIMITATION ON AGENT’S AUTHORITY
An agent that is not my ancestor, spouse or descendant MAY NOT use my property to
benefit the agent or a person to whom the agent owes an obligation of support unless I
have included that authority in the Special Instructions. SPECIAL INSTRUCTIONS (OPTIONAL)
You may give special instructions on the following lines: ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
4. INTERPRETATION AND GOVERNING LAW: This instrument is to be construed and
interpreted as a general durable power of attorney. The enumeration of specific powers
herein is not intended to, nor does it, limit or restrict the general powers herein grant ed to my
Agent. This instrument is executed and delivered in the State of Iowa, and the laws of t he
State of Iowa shall govern all questions as to the validity of this power and the construc tion
of its provisions. This instrument is intended to be effective in all states of the United States
and in all foreign countries.
5. INDEMNITY: I hereby bind myself to indemnify my Agent and any successor who shall so
act, against any and all claims, demands, losses, damages, actions and causes of acti on,
including expenses, costs and reasonable attorneys’ fees which my Agent at any time ma y
sustain or incur in connection with carrying out the authority granted her or him in this power
of attorney.
6. NOMINATION OF GUARDIAN OR CONSERVATOR: In the event court proceedings are
hereafter commenced to appoint a guardian, conservator or other fiduciary to take charge of
my person, or to manage and conserve my property, I hereby nominate and appoint my
Agent above-named, as my guardian, conservator, or other fiduciary, to serve without bond
unless otherwise required by a court of competent jurisdiction.
7. REVOCATION: This general durable power of attorney may be voluntarily revoked by me
by written instrument signed by me and delivered to my Agent. My guardian may also
revoke this instrument by written instrument signed by him or her and delivered to my Agent.
Any affidavit executed by my Agent stating that she or he does not have, at the time of doing
any act pursuant to this power of attorney, actual knowledge of the revocation or terminati on
of this power of attorney, is, in the absence of fraud, conclusive proof of the nonrevocation or
nontermination of the power at that time.
8. DEATH: My death shall not revoke or terminate this agency as to my Agent or any other
person who, without actual knowledge of my death, acts in good faith under this power of
attorney. Any action so taken, unless otherwise invalid or unenforceable, shall be binding
upon me and my heirs, devises, and personal representatives.
9. SUBSTITUTE AGENT: If
_______________________________ (Name of Agent/Attorney-in-
Fact) ceases to act as my Agent due to death, incapacity, or resignation, I appoint
__________________________________ (Name of Successor Agent/Attorney-in-Fact), to serve as
my Agent.
10. JOINT POWER: If I name two persons to serve as my Agent hereunder, it is my intent that
the power granted to them shall be a joint power, which shall and must be exercised by them
together as they may from time to time act on my behalf. No action or transac tion requiring
a signature will be effective or binding without both such persons’ signatures affixed to the
written instrument(s) reflecting the action or transaction.
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 sa id 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".
My agent is entitled to reasonable compensation and reimbursement for reasonable expenses for
services rendered as agent under this power of attorney, if desired.
TO INDUCE ANY THIRD PARTY TO ACT HEREUNDER, I HEREBY AGREE THAT
ANY THIRD PARTY RECEIVING A DULY EXECUTED COPY OR FACSIMILE
OF THIS INSTRUMENT MAY ACT HEREUNDER, AND THAT REVOCATION
OR TERMINATION HEREOF SHALL BE INEFFECTIVE AS TO SUCH THIRD
PARTY UNLESS AND UNTIL ACTUAL NOTICE OR KNOWLEDGE OF SUCH
REVOCATION OR TERMINATION SHALL HAVE BEEN RECEIVED BY SUCH
THIRD PARTY, AND I FOR MYSELF AND FOR MY HEIRS, EXECUTORS,
LEGAL REPRESENTATIVES AND ASSIGNS, HEREBY AGREE TO INDEMNIFY
AND HOLD HARMLESS ANY SUCH THIRD PARTY FROM AND AGAINST ANY
AND ALL CLAIMS THAT MAY ARISE AGAINST SUCH THIRD PARTY BY
REASON OF SUCH THIRD PARTY HAVING RELIED ON THE PROVISIONS OF
THIS INSTRUMENT.
THIS DURABLE GENERAL POWER OF ATTORNEY MAY BE REVOKED BY ME AT
ANY TIME.
Signed this _________ day of __________________________________________, 20________
_________________________________________
(Principal's Signature)
STATE OF IOWA
COUNTY OF __________________________________
On this ____ day of ______________________, 20____, before me, a Notary Public, personally
appeared ________________________________________________, to me known to be the
person named in and who executed the foregoing instrument, and acknowledged that he/she/they
executed the same as his/her/their voluntary act and deed. _________________________________________
Notary Public (Seal, if any)
Print Name: ________________________________________________
My commission expires: _____________________
