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Form preview Power of attorney nys oca form DURABLE GENERAL POWER OF ATTORNEY NEW YORK STATUTORY SHORT FORM THE POWERS YOU GRANT BELOW CONTINUE TO BE EFFECTIVE SHOULD YOU BECOME DISABLED OR INCOMPETENT (CAUTION: THIS IS AN IMPORTANT DOCUMENT.
Form preview Special power of attorney mili... SPECIAL POWER OF ATTORNEY MILITARY AFFAIRS PREAMBLE This is a military Power of Attorney prepared pursuant to Title 10 United States Code Section 1044b and executed by a person authorized to receive legal assistance from the military service. Federal law exempts this power of attorney from any requirement of form substance formality or recording that is prescribed for powers of attorney by the laws of a state the District of Columbia or a territ...
Form preview Affidavit power of attorney fo... THAT as attorney-in-fact of the Principal and under and by virtue of the Power of Attorney I have this day executed this Affidavit. THAT at the time of executing this Affidavit I had no actual knowledge or actual notice of revocation or termination of the Power of Attorney by death or otherwise or notice of any facts indicating the same. THAT I agree to indemnify the Bank and hold it harmless from all costs claims demands suits expenses including reasonable attorney s fees judgments and liabilities whatsoever arising out of any action taken by me which is inconsistent with this Affidavit or the Power of Attorney. AFFIDAVIT AS TO POWER OF ATTORNEY BEING IN FULL FORCE STATE OF COUNTY OF ss. being duly sworn deposes and says THAT as principal the Principal who resides at did in writing under date of the Power of Attorney appoint me his/her true and lawful attorney and that annexed hereto and hereby made a part hereof is a true copy of the Power of Attorney. THAT I make this Affidavit for the purpose of inducing JPMorgan Chase Bank N.A. the Bank to accept delivery of this Affidavit as executed by me in my capacity of attorney-in-fact of the Principal with the full knowledge that the Bank in accepting the execution and delivery of this Affidavit and the Power of Attorney will rely upon this Affidavit. THAT I hereby represent that the Principal is now alive has not at any time revoked or repudiated the Power of Attorney and the Power of Attorney is still in full force and effect. This includes acts done by me both before and after the Bank has received notice of the death of the Principal or of the modification or termination of the Power of Attorney. If the Bank and I become involved in a lawsuit arising out of the Power of Attorney or my action under it we both waive a trial by jury. This includes acts done by me both before and after the Bank has received notice of the death of the Principal or of the modification or termination of the Power of Attorney. If the Bank and I become involved in a lawsuit arising out of the Power of Attorney or my action under it we both waive a trial by jury.
Form preview Pharmacy power of attorney for... E-mail: pharmacy pharmacy.ok.gov ... This publication is issued by the Oklahoma State Board of Pharmacy as authorized by Title ..... Attorney General, Oklahoma Office of the ..... http://www.micromedex.com/products/pharmacists/
Form preview F00036 form If your agent is your spouse or domestic partner and your marriage is annulled or you are divorced or legally separated or the domestic partnership is terminated after signing this document the document is invalid. 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. DEPARTMENT OF HEALTH SERVICES Division of Public Health F-00036 Rev. 09/10 STATE OF WISCONSIN Effective Date September 1 2010 s. State of Wisconsin Department of Health Services This Power of Attorney for Finances form allows you to plan for future financial decision-making even if you are unable to make your own decisions. More information is available to assist you in filling out this form1. This form is not the answer for everyone. Only select someone you trust to be your agent. You may wish to consult with an attorney to explore other financial planning tools such as a Power of Attorney for Finances drafted by an attorney or special accounts or trusts. This is an important legal document. Do not sign it until you and your chosen agent understand the powers being granted* By signing this document you are not giving up any powers or rights to control your finances or property. Instead you are giving your agent in addition to yourself the authority to handle your finances and property. While it is not required that you sign this document in the presence of a notary acknowledged signatures create a lawful presumption of genuineness and will be more easily accepted by businesses and financial institutions. This document is effective immediately when executed unless you state a future date or occurrence that will activate the powers expressed in this form* you specifically state that it terminates if you become incapacitated* If you name your spouse or domestic partner as your agent and the marriage or domestic partnership is terminated annulment or divorce this document becomes invalid unless the special instructions in this document state that such an action will not terminate the authority given to the agent. If you used a former state Power of Attorney for Finances form that form is still valid* Executing a new Power of Attorney for Finances does not automatically revoke a prior document. If you wish to change this Power of Attorney for Finances in the future you must complete a new document and revoke this one. You may revoke this document at any time a suggested method is a written and dated statement expressing your intent to revoke this document. If you revoke this document you should notify your agent and any other persons or entities that have a copy. In general an agent who is not the principal s spouse or domestic partner may not use the principal s property for the benefit of the agent or a person to whom the agent owes an obligation of support. Gifting to others is also generally not allowed2. Your agent is entitled to reasonable compensation unless you state otherwise in the special instructions.
Form preview South carolina power attorney... SOUTH CAROLINA HEALTH CARE POWER OF ATTORNEY INFORMATION ABOUT THIS DOCUMENT THIS IS AN IMPORTANT LEGAL DOCUMENT. I am not appointed as Health Care Agent or Successor Health Care Agent by this document. Witness No. 1 Signature Date Print Name Telephone This portion of the document is optional and is not required to create a valid health care power of attorney. STATE OF SOUTH CAROLINA COUNTY OF The foregoing instrument was acknowledged before me by Principal on Notary Public for South Carolina My Commission Expires. ADMINISTRATIVE PROVISIONS A. I revoke any prior Health Care Power of Attorney and any provisions relating to health care of any other prior power of attorney. A BENEFICIARY OF A LIFE INSURANCE POLICY ON YOUR LIFE. E. THE PERSONS NAMED IN THE HEALTH CARE POWER OF ATTORNEY AS YOUR AGENT OR SUCCESSOR AGENT. Second Alternate Agent Unavailability of Agent s If at any relevant time the agent or successor agents named here are unable or unwilling to make decisions concerning my health care and those decisions are to be made by a guardian by the Probate Court or by a surrogate pursuant to the Adult Health Care Consent Act it is my intention that the guardian Probate Court or surrogate make those decisions in accordance with my directions as stated in this document. EFFECTIVE DATE AND DURABILITY By this document I intend to create a durable power of attorney effective upon and only during any period of mental incompetence except as provided in Paragraph 3 below. I am not entitled to any portion of the principal s estate upon his decease whether under any will or as an heir by intestate succession nor am I the beneficiary of an insurance policy on the principal s life nor do I have a claim against the principal s estate as of this time. I am not the principal s attending physician nor an employee of the attending physician. No more than one witness is an employee of a health facility in which the principal is a patient. I am not appointed as Health Care Agent or Successor Health Care Agent by this document. Witness No. 1 Signature Date Print Name Telephone This portion of the document is optional and is not required to create a valid health care power of attorney. I sign my name to this Health Care Power of Attorney on this day of 20. My current home address is Principal s Signature Print Name of Principal I declare on the basis of information and belief that the person who signed or acknowledged this document the principal is personally known to me that he/she signed or acknowledged this Health Care Power of Attorney in my presence and that he/she appears to be of sound mind and under no duress fraud or undue influence. I am not related to the principal by blood marriage or adoption either as a spouse a lineal ancestor descendant of the parents of the principal or spouse of any of them. I am not directly financially responsible for the principal s medical care. I am not entitled to any portion of the principal s estate upon his decease whether under any will or as an heir by intestate succession nor am I the beneficiary of an insurance policy on the principal s life nor do I have a claim against the principal s estate as of this time. B. This power of attorney is intended to be valid in any jurisdiction in which it is presented. BY SIGNING HERE I INDICATE THAT I UNDERSTAND THE CONTENTS OF THIS DOCUMENT AND THE EFFECT OF THIS GRANT OF POWERS TO MY AGENT. I sign my name to this Health Care Power of Attorney on this day of 20. My current home address is Principal s Signature Print Name of Principal I declare on the basis of information and belief that the person who signed or acknowledged this document the principal is personally known to me that he/she signed or acknowledged this Health Care Power of Attorney in my presence and that he/she appears to be of sound mind and under no duress fraud or undue influence. I am not related to the principal by blood marriage or adoption either as a spouse a lineal ancestor descendant of the parents of the principal or spouse of any of them. I am not directly financially responsible for the principal s medical care.
Form preview Tn department of revenue forms TENNESSEE DEPARTMENT OF REVENUE POWER OF ATTORNEY PART 1 Power of Attorney (Please type or print.) Account number(s) 1. Taxpayer Information (Taxpayer must sign and date this form on line 6.) Taxpayer
Form preview Dea 222 form order Power of Attorney for DEA Forms 222 and Electronic Orders (Name of registrant) (Address of registrant) (DEA registration number) I, (name of person granting power), the undersigned, who am authorized
Form preview Geico report claim form GOVERNMENT EMPLOYEES INSURANCE COMPANIES A Shareholder Owned Company Not Affiliated With The U.S. Government HOME OFFICE WASHINGTON, D.C. 20076 FOR REPORTING ACCIDENTS REPORT ALL ACCIDENTS OR LOSSES
Form preview Durable power of attorney form 2. CREATION OF DURABLE POWER OF ATTORNEY FOR HEALTH CARE By this document I intend to create a Durable Power of Attorney by appointing the person designated subsequent incapacity. Date 12/17/2010 YOUTH INDEPENDENT LIVING PROGRAM FPO 0801C - Durable Power Of Attorney For Healthcare Decisions 1. First Alternative Agent B. Second Alternative Agent 8. PRIOR DESIGNATIONS REVOKED I revoke any prior Durable Power of Attorney for Healthcare YOU MUST DATE AND SIGN THIS POWER OF ATTORNEY. I sign my name to this Durable Power of Attorney for Healthcare on Date City State Signature 9. WAIVER OF CONFLICT OF INTEREST. This Durable Power of Attorney for Health Care must be construed and interpreted in accordance with the laws of the State of Nevada. 11. WHAT is a Durable Power of Attorney Durable means that the document will remain in effect or take effect if you become mentally incompetent. You can also sign a durable power of attorney document to prepare for the possibility that you may become mentally incompetent due to illness or an accident. In exercising the authority under this Durable Power of Attorney for healthcare the authority of my agent is subject to the following special provisions and limitations 5. The relative or friend you choose to be your Agent will be acting for you regarding your healthcare issues. You need to choose someone who won t abuse the powers you give them and will look out for your best interests. WHAT is the Difference Between a POA and a Living Will Living Will because it allows you to choose someone only allows you to communicate your wishes concerning life-sustaining procedures. IS the POA an Advanced Heath Care Directive Both Living Wills and Healthcare Powers of Attorney are considered Advance Healthcare Directives because you re giving instructions on what you d want to happen in the event that you become unable Nevada also has a specific Advance Healthcare Directive document that combines elements of a a more in-depth look at Advance Healthcare Directives Healthcare Powers of Attorney and Living Wills link to http //nvsos. gov/index. aspx page 214 DO I have to Choose a Lawyer to be My Agent You don t have to choose a lawyer to be your Agent but it is important to select someone you trust. WHAT if the Person I Choose as Agent is Unable to Serve There is always the possibility that the person or organization you choose as your Agent either won t be able to serve or will refuse to serve. That s why you have the option of choosing a Successor Agent or second Agent who can take over as Agent if necessary. Here is an example of why choosing a Suc- cessor Agent is a good idea A young adult chooses a former teacher as their Agent. The teacher moves across the country to care for an aging parent and is no longer available to make decisions on behalf of the youth. If the youth had chosen a Successor Agent that person is then able to make decisions if necessary. WHERE Do I Get the Document Your caseworker will provide you with the POA document during your transition plan meeting.
Form preview Us bank power of attorney form LIMITED POWER OF ATTORNEY Know all men by these presents, that, I, of , do hereby make, constitute and appoint my my true and lawful attorney-in-fact for me in my name, place and stead to do, execute
Form preview Tn power attorney vehicle form Print Tennessee Department of Revenue Taxpayer and Vehicle Services Division Reset POWER OF ATTORNEY FOR VEHICLE TRANSACTIONS (Tenn. Code Ann. 34-6-101 and 102) Dealers must use a secure power of

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