Power of Attorney Trustees Form

POWER OF ATTORNEY TRUSTEES FORM

This Power of Attorney Trustees Form is executed on by Principal Name: whose address is (hereinafter "Principal"), appointing Trustee(s) Name(s): and Trustee Primary Address: (hereinafter "Trustee").

RECITALS

WHEREAS, Principal is the settlor or owner of certain property and accounts, including but not limited to assets held in trust or otherwise, which Principal desires to have managed for the Principal's benefit in accordance with the powers granted below; and

WHEREAS, Principal desires to appoint Trustee to act as attorney-in-fact with respect to those matters described herein, including management of trust property and exercise of fiduciary powers to the extent permitted by law; and

WHEREAS, Trustee has indicated a willingness to accept such appointment and to act in accordance with the duties and limitations set forth in this instrument.

NOW, THEREFORE, in consideration of the foregoing recitals and the mutual covenants contained herein, Principal hereby grants, conveys and appoints the powers set forth below to Trustee, subject to the terms and limitations of this instrument.

1. APPOINTMENT

Principal hereby appoints Trustee as attorney-in-fact and trustee to act in the name, place and stead of Principal with respect to the property and matters described in Section 2. The authority granted is fiduciary in nature and may be exercised by Trustee for the benefit of Principal and any beneficiary designated by the controlling trust instrument.

2. GENERAL AND SPECIFIC POWERS

Trustee is authorized to take any and all actions with respect to Principal's assets and affairs which Principal could lawfully take, including but not limited to the following specific powers. Each of the powers below is granted cumulatively and without limiting the generality of the foregoing appointment:

a. Real Property: To acquire, sell, convey, mortgage, lease, manage, insure, improve, encumber, partition, subdivide, or otherwise deal with real property on terms Trustee deems appropriate; to execute, acknowledge and deliver deeds, mortgages, releases and other instruments of conveyance or encumbrance.

b. Financial Transactions: To open, maintain and close accounts; to endorse checks and instruments; to withdraw and deposit funds; to execute transfer orders; and to handle banking, merchant and brokerage relationships.

c. Investments: To buy, sell, exchange, convert, pledge, or otherwise manage securities and other investments; to vote proxies; and to exercise rights and privileges of ownership with respect to investments.

d. Tax Matters: To prepare, sign, and file tax returns, to receive confidential tax information, to negotiate and settle tax liabilities, to engage tax professionals, and to act in all tax matters with the appropriate authorities.

e. Legal Actions and Claims: To commence, defend, settle or otherwise resolve litigation and administrative proceedings, to compromise claims, and to engage counsel on behalf of Principal or the trust.

f. Insurance and Benefits: To apply for, maintain, modify, cash, assign or surrender insurance policies, and to manage benefits relating to employment, retirement and social programs.

g. Gifts and Distributions: To make or withhold distributions, gifts, charitable contributions, or loans from trust or personal funds consistent with any directions in the controlling trust instrument or, absent such directions, in Trustee's reasonable discretion subject to the limitation set forth in Section 6.

3. SUCCESSOR TRUSTEE AND CO-TRUSTEE PROVISIONS

If Trustee is unable or unwilling to act, the following Successor Trustee shall serve: Successor Trustee Name: Successor Trustee Address: . If more than one Trustee is named, co-trustee action may be taken by majority action unless otherwise stated in the governing trust instrument.

4. EFFECTIVE DATE AND DURATION

This Power of Attorney shall become effective on the date of execution unless Principal indicates a delayed or springing commencement condition by checking the appropriate box below:

Effective immediately upon execution.
Effective upon Principal's incapacity as determined by physician(s). If springing, specify determining party or procedure:

Unless earlier revoked pursuant to law or Section 8, this Power of Attorney shall remain in force until Principal's death, resignation of Trustee, or written revocation.

5. DURABILITY

This Power of Attorney is intended to be durable. The authority of Trustee shall not be affected by Principal's subsequent incapacity or disability unless a contrary statement is made below: This instrument is not intended to be durable.

6. LIMITATIONS AND PROHIBITED ACTIONS

Trustee shall not: (a) make any lifetime disposition of Principal's property for Trustee's own benefit except as expressly permitted; (b) revoke or amend any trust created by Principal unless expressly authorized in the controlling trust instrument; or (c) exercise powers for purposes that are illegal or clearly contrary to the intent of Principal. Any exercise of discretionary power to make gifts must be consistent with tax and Medicaid planning objectives only if specifically directed in writing.

7. THIRD-PARTY RELIANCE AND INDEMNITY

Third parties may rely upon a copy of this document and are authorized to accept and act upon instructions of Trustee without further inquiry. Third parties who act in good faith in reliance upon this instrument shall be indemnified and held harmless by Principal and by any estate or trust for liabilities incurred as a result of accepting this Power of Attorney, except for willful misconduct or gross negligence.

8. REVOCATION

This Power of Attorney may be revoked by Principal at any time by written notice delivered to Trustee. Revocation shall not affect any action taken by Trustee in good faith prior to receipt of such notice by Trustee or third parties who reasonably relied on the pre-revocation authority.

9. NOTICES

Any notice or communication required or permitted under this instrument shall be in writing and delivered in person or by certified mail, return receipt requested, or by nationally recognized overnight courier, to the addresses set forth herein or to such other address as a party may designate in writing.

10. GOVERNING LAW

This Power of Attorney shall be governed by and construed in accordance with the laws of the State of , without regard to its choice of law provisions.

11. ENTIRE AGREEMENT

This instrument constitutes the entire Power of Attorney agreement between the parties with respect to the subjects herein and supersedes any prior oral or written powers of attorney executed by Principal with respect to the powers granted herein, except as expressly preserved in writing.

12. SEVERABILITY

If any provision of this document is found to be invalid or unenforceable, such invalidity shall not affect the remaining provisions, which shall remain in full force and effect to the maximum extent permitted by law.

13. AMENDMENT AND WAIVER

This Power of Attorney may be amended or supplemented only by a written instrument signed by Principal and Trustee. No waiver of any provision shall be effective unless in writing and signed by the party waiving compliance.

14. ACKNOWLEDGMENT AND CERTIFICATION

Principal certifies that Principal is of sound mind and legal capacity, is not acting under duress, undue influence or fraudulent inducement, and fully understands the nature and effect of granting the powers set forth herein. Principal further certifies that the powers granted are in Principal's best interest and for the benefit of Principal or Principal's beneficiaries.

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