Maryland Statutory Form

Maryland Statutory Form Limited Power of Attorney

PLEASE READ CAREFULLY

This power of attorney authorizes another person (your agent) to make decisions concerning your property for you (the principal). You need not give to your agent all the authorities listed below and may give the agent only those limited powers that you specifically indicate. This power of attorney gives your agent the right to make limited decisions for you. You should very carefully weigh your decision as to what powers you give your agent. Your agent will be able to make decisions and act with respect to your property (including your money) whether or not you are able to act for yourself.

If you choose to make a grant of limited authority, you should check the boxes that identify the specific authorization you choose to give your agent.

This power of attorney does not authorize the agent to make 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 indicate otherwise in the special instructions of this power of attorney. If you indicate that your agent is to receive compensation, your agent is entitled to reasonable compensation or compensation as specified in the Special Instructions.

This form provides for designation of one agent. If you wish to name more than one agent you may name a coagent in the Special Instructions. Coagents are required to act together unanimously unless you specify otherwise in the Special Instructions.

If your agent is unavailable 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.

This power of attorney becomes effective immediately unless you state otherwise in the Special Instructions.

If you have questions about the power of attorney or the authority you are granting to your agent, you should seek legal advice before signing this form.

Designation of Agent

This section of the form provides for designation of one agent. If you wish to name coagents, skip this section and use the next section ("Designation of Coagents").

I, , name the following person as my agent:

Name of Agent:

Agent's Address:

Agent's Telephone Number:

This section of the form provides for designation of two or more coagents. Coagents are required to act together unanimously unless you otherwise provide in this form.

I, , name the following persons as my coagents:

Name of Coagent:

Coagent's Address:

Coagent's Telephone Number:

Name of Coagent:

Coagent's Address:

Coagent's Telephone Number:

Special Instructions Regarding Coagents:

Designation of Successor Agent(s) (Optional)

If my agent is unable or unwilling to act for me, I name as my successor agent:

Name of Successor Agent:

Successor Agent's Address:

Successor Agent's Telephone Number:

If my successor agent is unable or unwilling to act for me, I name as my second successor agent:

Name of Second Successor Agent:

Second Successor Agent's Address:

Second Successor Agent's Telephone Number:

Grant of General Authority

I ("the principal") grant my agent and any successor agent, with respect to each subject that I choose below, the authority to do all acts that I could do to:

Demand, receive, and obtain by litigation or otherwise, money or another thing of value to which the principal is, may become, or claims to be entitled...

Contract with another person, on terms agreeable to the agent...

Execute, acknowledge, seal, deliver, file, or record any instrument or communication...

Initiate, participate in, submit to alternative dispute resolution, settle, oppose, or propose or accept a compromise...

Seek on the principal's behalf the assistance of a court or other governmental agency...

Engage, compensate, and discharge an attorney, accountant, discretionary investment manager, expert witness, or other advisor...

Prepare, execute, and file a record, report, or other document...

Communicate with representatives or employees of a government or governmental subdivision...

Access communications intended for, and communicate on behalf of the principal...

Do lawful acts with respect to the subject and all property related to the subject.

Initial each authority in any subject you want to include in the agent's general authority. Cross through each authority in any subject that you want to exclude. If you wish to grant general authority over an entire subject, you may initial "All of the above" instead of initialing each authority.

A. Real Property

Demand, buy, lease, receive, accept as a gift or as security for an extension of credit, or otherwise acquire or reject an interest in real property or a right incident to real property

Sell, exchange, convey with or without covenants, representations, or warranties...

Pledge or mortgage an interest in real property...

Release, assign, satisfy, or enforce by litigation or otherwise a mortgage, deed of trust...

Manage or conserve an interest in real property or a right incident to real property...

Use, develop, alter, replace, remove, erect, or install structures or other improvements on real property...

Participate in a reorganization with respect to real property or an entity that owns an interest...

Change the form of title of an interest in or a right incident to real property

Dedicate to public use, with or without consideration, easements or other real property...

All of the above

B. Tangible Personal Property

Demand, buy, receive, accept as a gift or as security for an extension of credit...

Sell, exchange, convey with or without covenants, representations, or warranties...

Grant a security interest in tangible personal property...

Release, assign, satisfy, or enforce by litigation or otherwise, a security interest...

Manage or conserve tangible personal property or an interest in tangible personal property...

Change the form of title of an interest in tangible personal property

All of the above

C. Stocks and Bonds

Buy, sell, and exchange stocks and bonds

Establish, continue, modify, or terminate an account with respect to stocks and bonds

Pledge stocks and bonds as security to borrow, pay, renew, or extend the time of payment of a debt

Receive certificates and other evidences of ownership

Exercise voting rights with respect to stocks and bonds in person or by proxy

All of the above

D. Commodities

Buy, sell, exchange, assign, settle, and exercise commodity futures contracts and call or put options

Establish, continue, modify, and terminate option accounts

All of the above

E. Banks and Other Financial Institutions

Continue, modify, transact all business in connection with, and terminate an account or other banking arrangement

Establish, modify, transact all business in connection with, and terminate an account or other banking arrangement with a financial institution

Contract for services available from a financial institution, including renting a safe deposit box

Deposit money or property of the principal

Withdraw money or property of the principal

Receive statements of account, vouchers, notices, and similar documents

Enter a safe deposit box or vault and withdraw or add to the contents

Borrow money and pledge personal property as security

Make, assign, draw, endorse, discount, guarantee, and negotiate promissory notes, checks, drafts, and other paper

Receive for the principal and act on a sight draft, warehouse receipt, or other document of title

Apply for, receive, and use letters of credit, credit cards and debit cards, electronic transaction authorizations, and traveler's checks

Consent to an extension of the time of payment with respect to commercial paper or a financial transaction

All of the above

F. Operation of an Entity or a Business

Operate, buy, sell, enlarge, reduce, or terminate an ownership interest

Perform a duty or discharge a liability and exercise rights, powers, privileges, or options

Enforce the terms of an ownership agreement

Initiate, participate in, submit to alternative dispute resolution, settle, oppose, or propose or accept a compromise with respect to litigation

Exercise rights as holder of stocks and bonds

Initiate, participate in, submit to alternative dispute resolution, settle, oppose, or propose or accept a compromise with respect to litigation concerning stocks and bonds

Continue, modify, renegotiate, extend, and terminate contracts for an entity or business

Determine business location, nature, methods, insurance, and employee/advisor arrangements

Change the name or form of organization under which the entity or business is operated

Demand and receive money due or claimed by the principal in operation of the entity or business

Put additional capital into an entity or a business

Join in a plan of reorganization, consolidation, conversion, domestication, or merger

Sell or liquidate all or part of an entity or business

Establish the value of an entity or a business under a buyout agreement

Prepare, sign, file, and deliver reports, compilations, returns, or other papers

Pay, compromise, or contest taxes, assessments, fines, or penalties

All of the above

G. Insurance and Annuities

Continue, pay the premium or make a contribution on, modify, exchange, rescind, release, or terminate a contract of insurance or annuity

Procure new, different, and additional contracts of insurance and annuities

Pay the premium or make a contribution on, modify, exchange, rescind, release, or terminate a contract of insurance or annuity procured by the agent

Apply for and receive a loan secured by a contract of insurance or annuity

Surrender and receive the cash surrender value on a contract of insurance or annuity

Exercise an election

Exercise investment powers available under a contract of insurance or annuity

Change the manner of paying premiums

Change or convert the type of insurance or annuity

Apply for and procure a benefit or assistance under a statute or regulation to guarantee or pay premiums

Collect, sell, assign, hypothecate, borrow against, or pledge the interest of the principal

Select the form and timing of the payment of proceeds

Pay, compromise or contest, and apply for refunds in connection with a tax or assessment related to insurance or annuity

All of the above

H. Estates, Trusts, and Other Beneficial Interests

Accept, receive, receipt for, sell, assign, pledge, or exchange a share in or payment from the fund described above

Demand or obtain money or another thing of value by litigation or otherwise

Exercise for the benefit of the principal a presently exercisable general power of appointment

Initiate, participate in, submit to alternative dispute resolution, settle, oppose, or propose or accept a compromise with respect to litigation affecting the principal's interest

Initiate, participate in, submit to alternative dispute resolution, settle, oppose, or propose or accept a compromise with respect to litigation to remove, substitute, or surcharge a fiduciary

Conserve, invest, disburse, or use anything received for an authorized purpose

Transfer an interest of the principal in real property, stocks and bonds, accounts with financial institutions or securities intermediaries, insurance, annuities, and other property to a revocable trust

Reject, renounce, disclaim, release, or consent to a reduction in or modification of a share in or payment from the fund described above

All of the above

I. Claims and Litigation

Assert and maintain before a court or administrative agency a claim, cause of action, counterclaim, offset, recoupment, or defense

Bring an action to determine adverse claims or intervene or otherwise participate in litigation

Seek provisional or intermediate relief and use an available procedure to effect or satisfy a judgment

Make or accept a tender, offer of judgment, or admission of facts

Submit to alternative dispute resolution, settle, and propose or accept a compromise

Waive service of process, accept service, appear, designate persons for service, and file or deliver stipulations and other instruments

Act for the principal with respect to bankruptcy or insolvency

Pay a judgment, award, or order against the principal or a settlement

Receive money or other thing of value paid in settlement or as proceeds of a claim or litigation

All of the above

J. Personal and Family Maintenance

Perform acts necessary to maintain the customary standard of living of the principal and related individuals

Make periodic payments of child support and other family maintenance

Provide living quarters for the individuals described above

Provide normal domestic help, vacations, travel, education, and other current living costs

Pay expenses for necessary health care and custodial care

Act as the principal's personal representative under HIPAA

Continue provisions for automobiles or other means of transportation

Maintain credit and debit accounts and open new accounts

Continue payments incidental to membership in a religious institution, club, society, order, or other organization

All of the above

K. Benefits from Governmental Programs or Civil or Military Service

Execute vouchers for allowances and reimbursements payable by a government

Take possession and order removal and shipment of property from a place of storage or safekeeping

Enroll in, apply for, select, reject, change, amend, or discontinue a benefit or program

Prepare, file, and maintain a claim for benefit or assistance

Initiate, participate in, submit to alternative dispute resolution, settle, oppose, or propose or accept a compromise concerning a benefit or assistance

Receive financial proceeds of a claim and conserve, invest, disburse, or use for a lawful purpose

All of the above

L. Retirement Plans

Select the form and timing of payments under a retirement plan and withdraw benefits from a plan

Make a rollover, including a direct trustee-to-trustee rollover

Establish a retirement plan in the principal's name

Make contributions to a retirement plan

Exercise investment powers available under a retirement plan

Borrow from, sell assets to, or purchase assets from a retirement plan

All of the above

M. Taxes

Prepare, sign, and file federal, state, local, and foreign tax returns, claims for refunds, requests for extension of time, petitions regarding tax matters, and other tax-related documents

Pay taxes due, collect refunds, post bonds, receive confidential information, and contest deficiencies

Exercise elections available to the principal under federal, state, local, or foreign tax law

Act for the principal in all tax matters for all periods before the taxing authority

All of the above

N. Gifts

Make outright gifts of part or all of the principal's property within annual federal gift tax exclusion limits

Consent to the splitting of a gift made by the principal's spouse

All of the above

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.

Create an inter vivos trust, or amend, revoke, or terminate an existing inter vivos trust

Make a gift, subject to 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

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:

Effective Date

This power of attorney is effective immediately unless I have stated otherwise in the Special Instructions.

Termination Date (Optional)

This power of attorney shall terminate on , 20____. (use a specific calendar date)

Nomination of Guardian (Optional)

If it becomes necessary for a court to appoint a guardian of my estate or guardian of my person, I nominate the following person(s) for appointment:

Name of nominee for guardian of my property:

My agent (or successor agent) named above

or

Nominee's address:

Nominee's telephone number:

Name of nominee for guardian of my person:

My agent (or successor agent) named above

or

Nominee's address:

Nominee's telephone number:

Signature and Acknowledgment

STATE OF MARYLAND

COUNTY OF

This document was acknowledged before me on by to be his/her act.

My commission expires:

Witness Attestation

The foregoing power of attorney was, on the date written above, published and declared by in our presence to be his/her power of attorney. We, in his/her presence and at his/her request, and in the presence of each other, have attested to the same and have signed our names as attesting witnesses.

Witness #1 Signature

Witness #2 Signature

This document prepared by:

Important Information for Agent

Agent's Duties

When you accept the authority granted under this power of attorney, a special legal relationship is created between you and the principal. This relationship imposes on you legal duties that continue until you resign or the power of attorney is terminated or revoked.

You must: (1) Do what you know the principal reasonably expects you to do with the principal's property or, if you do not know the principal's expectations, act in the principal's best interest; (2) Act with care, competence, and diligence for the best interest of the principal; (3) Do nothing beyond the authority granted in this power of attorney; and (4) Disclose your identity as an agent whenever you act for the principal by writing or printing the name of the principal and signing your own name as "agent".

Unless the Special Instructions in this power of attorney state otherwise, you must also:

(1) Act loyally for the principal's benefit;

(2) Avoid conflicts that would impair your ability to act in the principal's best interest;

(3) Keep a record of all receipts, disbursements, and transactions made on behalf of the principal;

(4) Cooperate with any person that has authority to make health care decisions for the principal; and

(5) Attempt to preserve the principal's estate plan if you know the plan and preserving the plan is consistent with the principal's best interest.

Termination of Agent's Authority

You must stop acting on behalf of the principal if you learn of any event that terminates this power of attorney or your authority under this power of attorney.

Events that terminate a power of attorney or your authority to act under a power of attorney include: death of the principal; revocation; termination event stated in the power of attorney; purpose fully accomplished; or legal action filed to end marriage or for legal separation, unless otherwise stated.

Liability of Agent

The meaning of the authority granted to you is defined in the Maryland Power of Attorney Act, Title 17 of the Estates and Trusts Article. If you violate the Maryland Power of Attorney Act or act outside the authority granted, you may be liable for any damages caused by your violation.

If there is anything about this document or your duties that you do not understand, you should seek legal advice.