Fill and Sign the Special Durable Power of Attorney for Bank Account Matters Illinois Form

SPECIAL DURABLE POWER OF ATTORNEY FOR BANK ACCOUNT MATTERS STATE OF ILLINOIS COUNTY OF ______________ KNOW ALL MEN BY THESE PRESENTS: That I, _________________________________ of _____________ County, Illinois, being of sound mind and memory, do hereby make, constitute and appoint ___________________________________as my true and lawful agent and attorney in fact (hereinafter sometimes called "my agent"), with full power and authority to act for me, individually, and in my name, place and stead, with reference to the transaction of any and all business related to or connected with my bank accounts at _________________________ Bank, ________________________________________________ (Address), ______________________(City), Illinois, __________(Zip Code) hereinafter “Bank”, including, but not limited to, the following: 1. Making deposits, transfers and withdrawals to or from any of my bank accounts at Bank. 2. Writing, making and endorsing checks, drafts and other instruments in connection with my bank accounts at Bank. 3. Opening new checking, savings, money market, certificates of deposit, IRA’s or other accounts in my name and maintaining same. 4. Approving and authorizing automatic withdrawals from my accounts. 5. Executing signature cards for accounts maintained or opened by my agent in my name. 6. Performing any and all other matters relating to, or in connection with, my bank accounts at Bank. I direct that the above-related powers and authority of my said agent shall be so exercisable and effective regardless of the fact that I may be mentally or physically incapacitated or incapable of understanding or unable to express myself or act in my own behalf at the time of any action on my behalf by said agent. Such incapacity, whether mental or physical, that I may exhibit shall not in any way interfere with the authority of my agent herein to act fully on my behalf according to the terms hereof. In other words, this Power of Attorney shall not be affected by the subsequent disability, incompetence or incapacity of the principal. And I do hereby undertake to ratify and confirm, all and singular, the acts heretofore performed and to be hereinafter performed by my said agents, acting in my name and on my behalf. Bank shall honor this Power of Attorney until and unless Bank receives written notice of revocation of same signed by me. Bank is hereby indemnified and shall be held harmless by the undersigned for any and all actions taken by my agent regarding my accounts at Bank, regardless of whether within the intended scope of this Power of Attorney or not; therefore, Bank shall have no liability for the actions of my agent or for following the directions of my agent in connection with my bank accounts at Bank. IN WITNESS WHEREFORE, I have executed this Special Power of Attorney on this the ____ day of ________________, 20___. _________________________________________ PRINCIPAL ______________________ Witness ______________________ Witness ATTESTATION The hereinafter named Witnesses, each declare under penalty of perjury under the laws of the State of Illinois, that the principal is personally known to us, that the principal signed and acknowledged this special power of attorney in our presence, that the principal appears to be of sound mind and under no duress, fraud or undue influence, that we are not the person appointed as attorney-in-fact by this document and that we witnessed this power of attorney in the presence of the principal. We are not related to the principal by blood, marriage or adoption, and to the best of our knowledge, are not entitled to any part of the estate of the principal upon the death of the principal under a will now existing or by operation of law. WITNESSES: ______________________________ Signature Print Name: ___________________________ Address: ______________________________ City: ________________ State: ___________ Zip: __________ WITNESSES: ______________________________ Signature Print Name: ___________________________ Address: ______________________________ City: ________________ State: ___________ Zip: __________ NOTICE TO AGENT When you accept the authority granted under this power of attorney a special legal relationship, known as agency, is created between you and the principal. Agency imposes upon you duties that continue until you resign or the power of attorney is terminated or revoked. As agent you must: (1) do what you know the principal reasonably expects you to do with the principal's property; (2) act in good faith for the best interest of the principal, using due care, competence, and diligence; (3) keep a complete and detailed record of all receipts, disbursements, and significant actions conducted for the principal; (4) attempt to preserve the principal's estate plan, to the extent actually known by the agent, if preserving the plan is consistent with the principal's best interest; and (5) cooperate with a person who has authority to make health care decisions for the principal to carry out the principal's reasonable expectations to the extent actually in the principal's best interest. As agent you must not do any of the following: (1) act so as to create a conflict of interest that is inconsistent with the other principles in this Notice to Agent; (2) do any act beyond the authority granted in this power of attorney; (3) commingle the principal's funds with your funds; (4) borrow funds or other property from the principal, unless otherwise authorized; (5) continue 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, such as the death of the principal, your legal separation from the principal, or the dissolution of your marriage to the principal. If you have special skills or expertise, you must use those special skills and expertise when acting for the principal. You must 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" in the following manner: "(Principal's Name) by (Your Name) as Agent" The meaning of the powers granted to you is contained in Section 3 - 4 of the Illinois Power of Attorney Act, which is incorporated by reference into the body of the power of attorney for property document. If you violate your duties as agent or act outside the authority granted to you, you may be liable for any damages, including attorney's fees and costs, caused by your violation. If there is anything about this document or your duties that you do not understand, you should seek legal advice from an attorney. Principal Name and Address Attorney-in-Fact Name and Address Name: Name: Address: Address: City: City: State: Zip: State: Zip: Phone: Phone: