Durable Power of Attorney: Essential Protection for All Family Structures

DURABLE POWER OF ATTORNEY

NOTICE

THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS:

1. THIS DOCUMENT GIVES THE PERSON YOU DESIGNATE AS YOUR AGENT THE POWER TO MAKE DECISIONS CONCERNING YOUR PROPERTY AND FINANCIAL AFFAIRS.

2. YOUR AGENT WILL HAVE BROAD POWERS TO HANDLE YOUR PROPERTY AND FINANCES, WHICH MAY INCLUDE POWERS TO ENCUMBER, SELL, OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU.

3. THE POWERS GRANTED BY THIS DOCUMENT WILL EXIST FOR AN INDEFINITE PERIOD OF TIME UNLESS YOU LIMIT THEIR DURATION IN THIS DOCUMENT.

4. IF YOU BECOME DISABLED OR INCAPACITATED, THIS DOCUMENT WILL CONTINUE TO GIVE YOUR AGENT THE AUTHORITY TO ACT ON YOUR BEHALF UNTIL SUCH TIME AS YOU REGAIN CAPACITY OR THE DOCUMENT IS REVOKED.

5. YOUR AGENT MUST ACT IN ACCORDANCE WITH YOUR REASONABLE EXPECTATIONS TO THE EXTENT ACTUALLY KNOWN AND OTHERWISE IN YOUR BEST INTEREST.

6. YOU HAVE THE RIGHT TO REVOKE THE AUTHORITY OF YOUR AGENT AT ANY TIME, PROVIDED YOU ARE COMPETENT TO DO SO.

7. THE PERSON YOU APPOINT AS YOUR AGENT HAS NO DUTY TO ACT UNLESS YOU SPECIFY OTHERWISE IN THIS DOCUMENT. HOWEVER, WHEN THE AGENT EXERCISES THIS POWER, THE AGENT MUST USE DUE CARE TO ACT IN YOUR BEST INTEREST AND IN ACCORDANCE WITH THIS DOCUMENT.

ARTICLE I: DESIGNATION OF AGENT

I, [PRINCIPAL NAME], residing at [PRINCIPAL ADDRESS], born on [PRINCIPAL DOB], telephone number [PRINCIPAL PHONE], email address [PRINCIPAL EMAIL] (hereinafter referred to as the "Principal"), hereby designate and appoint [AGENT NAME], residing at [AGENT ADDRESS], telephone number [AGENT PHONE], email address [AGENT EMAIL], whose relationship to me is [AGENT RELATIONSHIP] (hereinafter referred to as my "Agent"), as my true and lawful attorney-in-fact.

ARTICLE II: DESIGNATION OF SUCCESSOR AGENT(S)

If my Agent is unable or unwilling to serve, or resigns, or is removed by court order, or if my Agent is my spouse and a petition for dissolution, annulment, or legal separation is filed, I hereby appoint the following person(s) as my Successor Agent(s), to serve in the order listed:

1. First Successor Agent: [SUCCESSOR AGENT 1 NAME], residing at [SUCCESSOR AGENT 1 ADDRESS], telephone number [SUCCESSOR AGENT 1 PHONE], email address [SUCCESSOR AGENT 1 EMAIL], whose relationship to me is [SUCCESSOR AGENT 1 RELATIONSHIP].

2. Second Successor Agent: [SUCCESSOR AGENT 2 NAME], residing at [SUCCESSOR AGENT 2 ADDRESS], telephone number [SUCCESSOR AGENT 2 PHONE], email address [SUCCESSOR AGENT 2 EMAIL], whose relationship to me is [SUCCESSOR AGENT 2 RELATIONSHIP].

Any reference to my "Agent" in this document shall refer to the then-acting Agent or Successor Agent.

ARTICLE III: DESIGNATION OF CO-AGENTS

[SELECT ONE OF THE FOLLOWING OPTIONS:]

☐ I do not designate any Co-Agents.

☐ I hereby designate [CO-AGENT NAME], residing at [CO-AGENT ADDRESS], telephone number [CO-AGENT PHONE], email address [CO-AGENT EMAIL], whose relationship to me is [CO-AGENT RELATIONSHIP], to serve as Co-Agent with my Agent named above.

If I have designated Co-Agents, they shall act:

☐ Jointly, requiring the signature and consent of all Co-Agents for all actions.

☐ Severally, allowing any Co-Agent to act independently without the consent of the other Co-Agent(s).

☐ By majority decision, if more than two Co-Agents are serving.

ARTICLE IV: STATEMENT OF INTENT AND DURABILITY

This Power of Attorney is a Durable Power of Attorney, and the authority of my Agent shall not terminate if I become disabled, incapacitated, or incompetent. It is my intention and direction that the authority conferred herein shall be exercisable notwithstanding my physical disability, mental incompetence, or incapacity.

This Durable Power of Attorney is made pursuant to the laws of the state of [GOVERNING STATE], and I intend for it to be construed and interpreted in accordance with such laws.

ARTICLE V: EFFECTIVE DATE

[SELECT ONE OF THE FOLLOWING OPTIONS:]

☐ This Durable Power of Attorney shall become effective immediately upon my execution of this document and shall remain effective if I become disabled, incapacitated, or incompetent.

☐ This Durable Power of Attorney shall become effective only upon my incapacity or disability as determined pursuant to Article VI below, and shall remain in effect during such incapacity or disability.

ARTICLE VI: DETERMINATION OF INCAPACITY

For purposes of this Durable Power of Attorney, I shall be considered incapacitated or disabled if I am unable to manage my financial affairs, property, or business matters effectively for reasons such as mental illness, mental deficiency, physical illness or disability, chronic use of drugs or alcohol, confinement, detention by a foreign power, or disappearance.

Incapacity shall be determined by one of the following methods:

1. Written certification by two (2) licensed physicians who have personally examined me and determined that I am incapable of managing my financial affairs; or

2. Written certification by one (1) licensed physician who has personally examined me, together with the written certification of one (1) licensed psychologist or psychiatrist who has personally examined me, both determining that I am incapable of managing my financial affairs; or

3. A court order determining that I am incapacitated or disabled.

No person relying in good faith upon the representations of my Agent or Successor Agent(s) as to my incapacity or disability shall be liable to me, my estate, my heirs, successors, or assigns for recognizing the Agent's authority.

ARTICLE VII: GENERAL GRANT OF POWERS

I grant my Agent full power and authority to act on my behalf with respect to the following matters, to the extent permitted by applicable law:

A. General Powers

My Agent shall have the power to do and perform all acts, execute and deliver all documents, and take all steps that my Agent, in Agent's sole discretion, deems necessary or appropriate to conduct my affairs, including but not limited to the following powers:

1. To demand, receive, collect, hold, and possess any money, debts, accounts, legacies, bequests, devises, interests, dividends, annuities, and demands as are now or shall hereafter become due, payable, or belonging to me, and take all lawful means for the recovery thereof and to compromise the same;

2. To buy, sell, exchange, lease, grant options to purchase, and otherwise deal with all real property, improved or unimproved, and any interest therein, on such terms and conditions as my Agent shall deem proper;

3. To buy, sell, exchange, and otherwise deal with all tangible and intangible personal property, on such terms and conditions as my Agent shall deem proper;

4. To have access to any safe deposit box registered in my name alone or jointly with others, and to remove any property or papers located therein;

5. To conduct, maintain, and terminate accounts with financial institutions, including brokerage houses, banks, credit unions, and other institutions, including the authority to make deposits, withdrawals, and negotiate or endorse any checks or other instruments with respect to any such accounts;

6. To borrow money and to pledge as security for such loans any assets belonging to me;

7. To prepare, sign, and file all tax returns and other governmental reports, forms, and documents, and to represent me before governmental agencies;

8. To vote any shares of stock or other securities and to exercise any options, rights, or privileges attendant upon such securities;

9. To claim, sue for, and receive any property, debt, damages, or thing of value due to me;

10. To commence, prosecute, discontinue, or defend all actions or other legal proceedings touching my estate or any part thereof, or touching any matter in which I or my estate may be in any way concerned;

11. To engage, employ, and dismiss any accountants, attorneys, consultants, custodians, employees, investment advisors, and other professionals as my Agent shall deem necessary or appropriate;

12. To make gifts on my behalf, subject to the limitations set forth in Article VIII of this document;

13. To create, amend, supplement, or terminate any trust for my benefit, and to transfer any property to the trustee of any trust for my benefit;

14. To disclaim any interest in property;

15. To execute and deliver any deeds, contracts, mortgages, promissory notes, bills of sale, or other documents necessary or appropriate to carry out the powers granted herein.

B. Real Estate Transactions

Without limiting the generality of the foregoing, my Agent shall have the following powers with respect to real estate:

1. To sell, exchange, convey with or without covenants, quitclaim, release, surrender, mortgage, encumber, partition or consent to partitioning, grant options concerning, lease or sublet, or otherwise dispose of any real property or any interest therein that I now own or may hereafter acquire, under such terms and conditions, and with such covenants, as my Agent shall deem proper;

2. To maintain, repair, improve, manage, insure, rent, lease, or otherwise deal with any real property or any interest therein that I now own or may hereafter acquire, in any way and for any period of time;

3. To prosecute, defend, submit to arbitration, settle, and propose or accept a compromise with respect to any claim existing in favor of or against me based on or involving any real property transaction;

4. To hire property managers or other professionals to assist in the management of my real property;

5. To pay, contest, or settle any taxes, assessments, or other charges or claims related to my real property;

6. To execute, acknowledge, seal, and deliver any deed, mortgage, lease, notice of lease, reconveyance, release, satisfaction, or other instrument necessary or appropriate to carry out the powers granted herein.

C. Financial Institution Transactions

My Agent shall have the following powers with respect to financial institutions:

1. To open, maintain, or close bank accounts, brokerage accounts, or other financial accounts in my name, either individually or jointly with others;

2. To conduct banking transactions, including but not limited to making deposits and withdrawals, obtaining bank statements, passbooks, drafts, money orders, warrants, and certificates or vouchers payable to me by any person, firm, corporation, or political entity;

3. To prepare, sign, and file all tax returns and other governmental reports, forms, and documents, and to represent me before governmental agencies;

4. To access, control, and conduct transactions in any digital assets or accounts I may own, including cryptocurrencies, online payment systems, and other digital or virtual assets;

5. To pay bills and make other disbursements on my behalf;

6. To invest and reinvest my assets in stocks, bonds, mutual funds, certificates of deposit, annuities, and other investments as my Agent deems appropriate;

7. To borrow money at such rates of interest and upon such terms and conditions as my Agent shall deem appropriate, including from or through banks, credit unions, financial institutions, or other lenders, and to secure such loans by mortgage or pledge of any real or personal property belonging to me;

8. To modify, terminate, or change any account or investment, including adjusting investment strategies, risk tolerance, or asset allocation as my Agent deems appropriate;

9. To hire and fire financial advisors, accountants, or other professionals to assist in the management of my financial affairs.

D. Business Operation Transactions

My Agent shall have the following powers with respect to business operations:

1. To operate, maintain, expand, reduce, sell, or terminate any business interest I may own;

2. To perform any duty and exercise any right, power, privilege, or option that I have or would have relating to any business in which I have an interest, including but not limited to partnerships, joint ventures, sole proprietorships, corporations, or limited liability companies;

3. To execute partnership agreements and amendments to partnership agreements;

4. To incorporate, reorganize, merge, consolidate, recapitalize, dissolve, liquidate, or sell or transfer all or any part of any entity;

5. To prepare, sign, and file all tax returns, regulatory filings, and other documents related to my business interests;

6. To hire and fire employees, contractors, and other personnel;

7. To enter into, modify, or terminate contracts related to the business;

8. To collect and receive profits, dividends, distributions, or other income from any business;

9. To vote any shares of stock or exercise any other ownership rights with respect to any business entity in which I have an interest;

10. To sell or liquidate any business or business interest on such terms and conditions as my Agent deems appropriate, with or without providing for the continuation of such business.

E. Retirement Plan Transactions

My Agent shall have the following powers with respect to retirement plans:

1. To contribute to, withdraw from, and deposit funds in any retirement plan in which I participate, including but not limited to IRAs, 401(k)s, 403(b)s, profit-sharing plans, pension plans, and annuities;

2. To select, change, or terminate investment options within any retirement plan;

3. To make rollover contributions from any retirement plan to other retirement plans or accounts;

4. To execute, assign, deliver, or receive any documents or instruments related to retirement plans;

5. To designate or change beneficiaries for any retirement plan, subject to any limitations elsewhere in this document;

6. To borrow from any retirement plan as permitted by the terms of the plan;

7. To make required minimum distributions or other mandatory distributions;

8. To elect, change, or terminate payment options for any retirement plan;

9. To prepare, sign, and file any documents related to retirement plans with government agencies or plan administrators;

10. To hire and fire financial advisors, accountants, or other professionals to assist in the management of my retirement accounts.

F. Government Benefits

My Agent shall have the following powers with respect to government benefits:

1. To prepare, sign, and file applications or other documents for Social Security, Medicare, Medicaid, Supplemental Security Income, veterans' benefits, or other government programs or civil service benefits for which I may be eligible;

2. To collect, deposit, and manage any benefits received;

3. To represent me in all proceedings before any governmental agency;

4. To appeal any denial of benefits;

5. To hire attorneys, advocates, or other professionals to assist in obtaining or maintaining government benefits;

6. To handle any financial transactions related to government benefits, including directing deposits, managing benefit-related accounts, and paying premiums;

7. To obtain information from any government agency regarding benefits for which I may be eligible;

8. To enroll in, change, or terminate Medicare or other government health insurance programs, including selecting supplemental insurance policies;

9. To apply for and manage long-term care benefits under Medicaid or other programs.

G. Tax Matters

My Agent shall have the following powers with respect to tax matters:

1. To prepare, sign, and file federal, state, local, and foreign income, gift, payroll, property, and other tax returns and other governmental reports, forms, and documents, including but not limited to requests for extension of time, tax information authorization forms, and agreements to settle tax matters;

2. To pay taxes due, collect refunds, post bonds, receive confidential information, and contest deficiencies determined by the Internal Revenue Service or other taxing authorities;

3. To exercise any right I may have to protest or appeal any tax assessment or determination;

4. To represent me before any federal, state, or local tax authority;

5. To engage tax professionals, including accountants and attorneys, to represent me before taxing authorities;

6. To sign waivers of restriction on assessment or collection of tax deficiencies and waivers of notice of disallowance of a claim for credit or refund;

7. To allocate or reallocate items of income, deduction, or credit between tax returns as permitted by law;

8. To make tax elections;

9. To pay estimated taxes and make other tax planning decisions;

10. To receive, endorse, and collect any checks in payment of any refund of taxes, penalties, or interest.

H. Legal Matters

My Agent shall have the following powers with respect to legal matters:

1. To engage, employ, and dismiss attorneys, paralegals, and other legal professionals to represent me in any legal matter;

2. To commence, prosecute, discontinue, defend, or settle claims or litigation involving me or my property;

3. To file, prosecute, defend, settle, or dismiss any civil or administrative action or proceeding on my behalf;

4. To receive and act on any notice, claim, or demand on my behalf;

5. To represent me in any proceeding before any court, administrative board, or other tribunal;

6. To execute and deliver any instruments necessary to carry out any of these powers;

7. To submit to alternative dispute resolution, mediation, or arbitration any dispute involving me or my property;

8. To pay judgments against me and compromise or settle claims or litigation;

9. To accept service of process on my behalf;

10. To sign waivers, releases, or settlements of claims.

ARTICLE VIII: LIMITATIONS ON AGENT'S POWERS

A. Excluded Powers

Notwithstanding any provision contained herein to the contrary, my Agent shall NOT have the power or authority to:

1. Create, amend, revoke, or terminate any will, codicil, or testamentary instrument on my behalf;

2. Make, modify, amend, or revoke any of my beneficiary designations, except as specifically authorized elsewhere in this document;

3. Create or change survivorship features of any of my accounts or property, except as specifically authorized elsewhere in this document;

4. Create or change any Transfer on Death (TOD) or Payable on Death (POD) designation, except as specifically authorized elsewhere in this document;

5. Make health care decisions on my behalf, which shall be governed by any Health Care Power of Attorney or Advance Directive I may execute;

6. Exercise any powers I have as a trustee, personal representative, custodian for a minor, conservator, guardian, or other fiduciary capacity;

7. Exercise any powers I may have as an attorney-in-fact, agent, or representative for another person;

8. Exercise any powers that would cause assets of mine to be considered taxable in my Agent's estate for estate tax purposes or that would cause assets of mine to be subject to a general power of appointment by my Agent;

9. Exercise any incidents of ownership with respect to any life insurance policies that I own on the life of my Agent;

10. [OTHER SPECIFIC LIMITATIONS].

B. Limitations on Gifting Powers

My Agent may make gifts of my property only as follows:

1. My Agent may make gifts only to my spouse, descendants, and other relatives not more remote than first cousins, or to the spouses of these individuals, or to charities to which I have made gifts in the past, or to charities in which my Agent reasonably believes I would have an interest.

2. The amount of gifts to any one donee in any calendar year shall not exceed the annual federal gift tax exclusion amount in effect at the time of the gift. If my spouse consents to split gifts, then the amount of such gifts shall not exceed twice the annual federal gift tax exclusion amount.

3. My Agent may make gifts to himself or herself only if my Agent is a permitted donee as described above, and only to the extent that gifts to other donees of the same class (e.g., children, nieces/nephews) are made in substantially equal amounts, taking into consideration prior gifts made by me during the same time period.

4. All gifts made by my Agent must be consistent with my objectives, as determined by my Agent in good faith. In determining my objectives, my Agent shall consider my history of making (or declining to make) gifts, my estate planning objectives, the minimization of taxes, and my financial needs and circumstances.

5. My Agent shall not make any gift that would be inconsistent with my existing estate plan or that would adversely affect the eligibility of me or my spouse for any government benefit or assistance.

ARTICLE IX: FIDUCIARY OBLIGATIONS OF AGENT

A. Fiduciary Duties

My Agent shall have a fiduciary relationship with me and shall act only in my best interest and within the scope of authority granted in this document. Specifically, my Agent shall:

1. Act loyally for my benefit;

2. Act so as not to create a conflict of interest that impairs the Agent's ability to act impartially;

3. Act with care, competence, and diligence ordinarily exercised by agents in similar circumstances;

4. Keep a record of all receipts, disbursements, and transactions made on my behalf;

5. Cooperate with any person who has authority to make health care decisions for me to ensure my desires regarding health care and related matters are carried out;

6. Attempt to preserve my estate plan, to the extent actually known by the Agent, if preserving the plan is consistent with my best interest based on all relevant factors, including: a. The value and nature of my property; b. My foreseeable obligations and need for maintenance; c. Minimization of taxes, including income, estate, inheritance, generation-skipping transfer, and gift taxes; d. Eligibility for a benefit, a program, or assistance under a statute or regulation.

7. Not delegate authority to another person except as authorized in this document or as permitted by law;

8. Not resign without giving notice to me, my guardian if I have one, any co-agent or successor agent, or my caregiver or another person reasonably believed to have sufficient interest in my welfare;

9. Maintain my property separate from anyone else's property, including the Agent's property;

10. Exercise reasonable caution and prudence when managing my property and financial affairs.

B. Record-Keeping Requirements

My Agent shall maintain accurate records of all transactions undertaken on my behalf, including:

1. An inventory of all property received on my behalf;

2. A record of all funds collected and paid out on my behalf;

3. A record of all significant actions taken on my behalf;

4. Copies of all documents executed on my behalf;

5. Receipts for all expenditures made on my behalf;

6. Documentation of the time spent acting as my Agent, if my Agent is to receive compensation.

C. Reporting Requirements

My Agent shall provide an accounting of all transactions undertaken on my behalf as follows:

1. Upon my request;

2. Upon request from any guardian or conservator appointed for me;

3. Upon request from any other fiduciary acting on my behalf;

4. Upon request from my spouse or from any of my adult children;

5. Upon termination of the agency relationship;

6. As ordered by a court.

Such accounting shall include:

1. A listing of all property received and disbursed;

2. A listing of all significant actions taken on my behalf;

3. Copies of all documents executed on my behalf, if requested;

4. A statement of the balance of any accounts maintained on my behalf.

ARTICLE X: COMPENSATION AND REIMBURSEMENT

A. Agent Compensation

[SELECT ONE OF THE FOLLOWING OPTIONS:]

☐ My Agent shall serve without compensation.

☐ My Agent shall be entitled to reasonable compensation for services performed as my Agent. Reasonable compensation shall be determined based on the time spent, complexity of tasks performed, level of expertise required, and prevailing rates for similar services in the community.

☐ My Agent shall be compensated at the rate of $[COMPENSATION AMOUNT] per [hour/month/year] for services performed as my Agent.

B. Expense Reimbursement

My Agent shall be entitled to reimbursement for all reasonable expenses incurred on my behalf, including but not limited to:

1. Travel expenses, including mileage at the then-current IRS rate, parking, tolls, and other transportation costs;

2. Postage, copying, and other administrative expenses;

3. Long-distance telephone charges, cellular phone charges, and other communication expenses;

4. Fees paid to third parties, such as attorneys, accountants, real estate brokers, or other professionals;

5. Court costs, filing fees, and other legal expenses;

6. Any other reasonable out-of-pocket expenses incurred in the proper execution of the Agent's duties.

My Agent shall maintain detailed records of all expenses for which reimbursement is sought, including receipts where available.

ARTICLE XI: TERMINATION

A. Revocation by Principal

I reserve the right to revoke or terminate this Durable Power of Attorney at any time by:

1. Executing a written revocation delivered to my Agent and any third parties who have relied on this Power of Attorney;

2. Executing a new Durable Power of Attorney that explicitly revokes this Power of Attorney;

3. Any other manner permitted by law.

B. Automatic Termination

This Durable Power of Attorney shall automatically terminate upon:

1. My death;

2. If my Agent is my spouse, upon the filing of an action for divorce, legal separation, annulment, or dissolution of our marriage, unless this document expressly provides otherwise;

3. If a court appoints a conservator, guardian, or other fiduciary to manage my property, unless the court specifically rules that this Power of Attorney shall continue;

4. By court order;

5. If I have specified a termination date in this document, upon that date.

C. Resignation of Agent

My Agent may resign by giving written notice to me. If I am incapacitated, my Agent may resign by giving written notice to:

1. My guardian or conservator, if one has been appointed;

2. Any co-agent or successor agent;

3. If there is no person described in (1) or (2), to: a. My caregiver; b. Another person reasonably believed to have sufficient interest in my welfare; or c. A governmental agency having authority to protect me.

ARTICLE XII: HIPAA AUTHORIZATION

I intend for my Agent to be treated as I would be with respect to my rights regarding the use and disclosure of my individually identifiable health information or other medical records. This release authority applies to any information governed by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 42 U.S.C. 1320d and 45 CFR 160-164, and the regulations promulgated thereunder.

I authorize any physician, healthcare professional, dentist, health plan, hospital, clinic, laboratory, pharmacy, or other covered healthcare provider, any insurance company, and the Medical Information Bureau, Inc., or other healthcare clearinghouse that has provided treatment or services to me, or that has paid for or is seeking payment from me for such services, to give, disclose, and release to my Agent, without restriction, all of my individually identifiable health information and medical records regarding any past, present, or future medical or mental health condition.

The authority given my Agent shall supersede any prior agreement that I may have made with my healthcare providers to restrict access to or disclosure of my individually identifiable health information. The authority given my Agent has no expiration date and shall expire only in the event that I revoke the authority in writing and deliver it to my healthcare provider.

ARTICLE XIII: RELATIONSHIP TO OTHER LEGAL DOCUMENTS

A. Relationship to Healthcare Directives

This Durable Power of Attorney is intended to address financial and property matters only. It does not grant my Agent authority to make healthcare decisions on my behalf. Such decisions shall be governed by any Healthcare Power of Attorney, Living Will, or other Advance Directive I may execute. However, my Agent under this document may use my financial resources to pay for my healthcare needs as directed by my healthcare agent or as otherwise appropriate.

B. Relationship to Trust Documents

This Durable Power of Attorney is separate from any trust agreement I may have executed or may execute in the future. My Agent's authority under this document does not extend to assets held in trust, which shall be governed by the terms of the applicable trust agreement. However, my Agent may transfer my assets to any trust created by me or for my benefit if my Agent determines such transfer to be in my best interest.

ARTICLE XIV: MISCELLANEOUS PROVISIONS

A. Severability Clause

If any provision of this Durable Power of Attorney, or the application thereof to any person or circumstance, is held invalid, void, unenforceable, or illegal for any reason, such invalidity, voidness, unenforceability, or illegality shall not affect the remaining provisions or applications of this document, which can be given effect without the invalid, void, unenforceable, or illegal provision or application. To this end, the provisions of this Durable Power of Attorney are declared to be severable. If any provision shall be invalid due to its scope or breadth, such provision shall be valid to the extent of the scope or breadth permitted by law.

B. Third-Party Reliance Protection

No person who relies in good faith upon the authority granted to my Agent in this document shall be liable to me, my estate, my heirs, successors, or assigns for actions or omissions by my Agent. Any person who deals with my Agent in good faith may rely upon this Durable Power of Attorney and need not ensure that my Agent is acting properly. The revocation or termination of this Durable Power of Attorney shall not be effective as to any third party until such third party has actual knowledge of such revocation or termination.

C. Photocopies and Electronic Copies

Photocopies and electronically transmitted copies (including facsimile and scanned copies) of this Durable Power of Attorney shall have the same effect as the original. Any person may rely on a copy of this document that my Agent certifies to be a true copy of this Durable Power of Attorney.

D. Governing Law

This Durable Power of Attorney shall be governed by the laws of the state of [GOVERNING STATE], without giving effect to principles of conflicts of laws. Any action to interpret or enforce this document shall be brought in the courts of [GOVERNING STATE].

E. Headings and Titles

The headings and titles used in this document are for convenience only and shall not be considered in interpreting this document.

F. Entire Agreement

This document contains the entire agreement between me and my Agent with respect to the subject matter hereof and supersedes all prior agreements and understandings, whether written or oral, relating to the subject matter hereof.

ARTICLE XV: SIGNATURE AND ACKNOWLEDGMENT

IN WITNESS WHEREOF, I have hereunto set my hand and seal this _____ day of ________________, [YEAR].

[PRINCIPAL NAME], Principal

WITNESSES

The foregoing instrument was signed, published, and declared by [PRINCIPAL NAME] as his/her Durable Power of Attorney, in our presence, and we, at his/her request and in his/her presence, and in the presence of each other, have subscribed our names as witnesses thereto, believing said [PRINCIPAL NAME] to be of sound mind and memory.

Witness Signature

Printed Name

Address

City, State, ZIP

Witness Signature

Printed Name

Address

City, State, ZIP

NOTARY ACKNOWLEDGMENT

STATE OF ___________________ COUNTY OF _________________

On this _____ day of ________________, [YEAR], before me personally appeared [PRINCIPAL NAME], to me known to be the person described in and who executed the foregoing instrument, and acknowledged that he/she executed the same as his/her free act and deed.

Notary Public My Commission Expires: _____________

AGENT ACCEPTANCE

I, [AGENT NAME], have read the foregoing Durable Power of Attorney and am the person identified as the Agent for [PRINCIPAL NAME]. I hereby acknowledge that when I act as Agent:

1. I shall act in accordance with the principal's reasonable expectations to the extent actually known by me and, otherwise, in the principal's best interest;

2. I shall act in good faith;

3. I shall act only within the scope of authority granted in the power of attorney; and

4. I shall keep a record of all receipts, disbursements, and transactions made on behalf of the principal.

[AGENT NAME], Agent Date: _____________________________