Download and Print this form to appoint someone else to make decisions on your behalf. This form is applicable only in the State of California.
Text Version of this Form
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THE POWERS YOU GRANT BELOW ARE EFFECTIVE
EVEN IF YOU BECOME DISABLED OR INCOMPETENT
CAUTION: A DURABLE POWER OF ATTORNEY IS AN IMPORTANT LEGAL DOCUMENT.
BY SIGNING THE DURABLE POWER OF ATTORNEY, YOU ARE AUTHORIZING ANOTHER
PERSON TO ACT FOR YOU, THE PRINCIPAL. BEFORE YOU SIGN THIS DURABLE POWER
OF ATTORNEY, YOU SHOULD KNOW THESE IMPORTANT FACTS: YOUR AGENT
(ATTORNEY-IN-FACT) HAS NO DUTY TO ACT UNLESS YOU AND YOUR AGENT AGREE
OTHERWISE IN WRITING. THIS DOCUMENT GIVES YOUR AGENT THE POWERS TO
MANAGE, DISPOSE OF, SELL, AND CONVEY YOUR REAL AND PERSONAL PROPERTY,
AND TO USE YOUR PROPERTY AS SECURITY IF YOUR AGENT BORROWS MONEY ON
YOUR BEHALF. THIS DOCUMENT DOES NOT GIVE YOUR AGENT THE POWER TO
ACCEPT OR RECEIVE ANY OF YOUR PROPERTY, IN TRUST OR OTHERWISE, AS A GIFT,
UNLESS YOU SPECIFICALLY AUTHORIZE THE AGENT TO ACCEPT OR RECEIVE A GIFT.
YOUR AGENT WILL HAVE THE RIGHT TO RECEIVE REASONABLE PAYMENT FOR
SERVICES PROVIDED UNDER THIS DURABLE POWER OF ATTORNEY UNLESS YOU
PROVIDE OTHERWISE IN THIS POWER OF ATTORNEY. THE POWERS YOU GIVE YOUR
AGENT WILL CONTINUE TO EXIST FOR YOUR ENTIRE LIFETIME, UNLESS YOU STATE
THAT THE DURABLE POWER OF ATTORNEY WILL LAST FOR A SHORTER PERIOD OF
TIME OR UNLESS YOU OTHERWISE TERMINATE THE DURABLE POWER OF ATTORNEY.
THE POWERS YOU GIVE YOUR AGENT IN THIS DURABLE POWER OF ATTORNEY WILL
CONTINUE TO EXIST EVEN IF YOU CAN NO LONGER MAKE YOUR OWN DECISIONS
RESPECTING THE MANAGEMENT OF YOUR PROPERTY. YOU CAN AMEND OR CHANGE
THIS DURABLE POWER OF ATTORNEY ONLY BY EXECUTING A NEW DURABLE POWER
OF ATTORNEY OR BY EXECUTING AN AMENDMENT THROUGH THE SAME FORMALITIES
AS AN ORIGINAL. YOU HAVE THE RIGHT TO REVOKE OR TERMINATE THIS DURABLE
POWER OF ATTORNEY AT ANY TIME, SO LONG AS YOU ARE COMPETENT.
THIS DURABLE POWER OF ATTORNEY MUST BE DATED AND MUST BE
ACKNOWLEDGED BEFORE A NOTARY PUBLIC OR SIGNED BY TWO WITNESSES. IF IT IS
SIGNED BY TWO WITNESSES, THEY MUST WITNESS EITHER (1) THE SIGNING OF THE
POWER OF ATTORNEY OR (2) THE PRINCIPAL’S SIGNING OR ACKNOWLEDGMENT OF
HIS OR HER SIGNATURE. A DURABLE POWER OF ATTORNEY THAT MAY AFFECT REAL
PROPERTY SHOULD BE ACKNOWLEDGED BEFORE A NOTARY PUBLIC SO THAT IT MAY
EASILY BE RECORDED.
YOU SHOULD READ THIS DURABLE POWER OF ATTORNEY CAREFULLY. WHEN
EFFECTIVE, THIS DURABLE POWER OF ATTORNEY WILL GIVE YOUR AGENT THE RIGHT
TO DEAL WITH PROPERTY THAT YOU NOW HAVE OR MIGHT ACQUIRE IN THE FUTURE.
THE DURABLE POWER OF ATTORNEY IS IMPORTANT TO YOU. IF YOU DO NOT
UNDERSTAND THE DURABLE POWER OF ATTORNEY, OR ANY PROVISION OF IT, THEN
YOU SHOULD OBTAIN THE ASSISTANCE OF AN ATTORNEY OR OTHER QUALIFIED
NOTICE TO PERSON ACCEPTING THE APPOINTMENT AS ATTORNEY-IN-FACT BY
ACTING OR AGREEING TO ACT AS THE AGENT (ATTORNEY-IN-FACT) UNDER THIS
POWER OF ATTORNEY YOU ASSUME THE FIDUCIARY AND OTHER LEGAL
RESPONSIBILITIES OF AN AGENT. THESE RESPONSIBILITIES INCLUDE:
1. THE LEGAL DUTY TO ACT SOLELY IN THE INTEREST OF THE PRINCIPAL AND TO
AVOID CONFLICTS OF INTEREST.
2. THE LEGAL DUTY TO KEEP THE PRINCIPAL’S PROPERTY SEPARATE AND DISTINCT
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FROM ANY OTHER PROPERTY OWNED OR CONTROLLED BY YOU. YOU MAY NOT
TRANSFER THE PRINCIPAL’S PROPERTY TO YOURSELF WITHOUT FULL AND
ADEQUATE CONSIDERATION OR ACCEPT A GIFT OF THE PRINCIPAL’S PROPERTY
UNLESS THIS POWER OF ATTORNEY SPECIFICALLY AUTHORIZES YOU TO TRANSFER
PROPERTY TO YOURSELF OR ACCEPT A GIFT OF THE PRINCIPAL’S PROPERTY. IF YOU
TRANSFER THE PRINCIPAL’S PROPERTY TO YOURSELF WITHOUT SPECIFIC
AUTHORIZATION IN THE POWER OF ATTORNEY, YOU MAY BE PROSECUTED FOR
FRAUD AND/OR EMBEZZLEMENT. IF THE PRINCIPAL IS 65 YEARS OF AGE OR OLDER
AT THE TIME THAT THE PROPERTY IS TRANSFERRED TO YOU WITHOUT AUTHORITY,
YOU MAY ALSO BE PROSECUTED FOR ELDER ABUSE UNDER PENAL CODE SECTION
368. IN ADDITION TO CRIMINAL PROSECUTION, YOU MAY ALSO BE SUED IN CIVIL
COURT. I HAVE READ THE FOREGOING NOTICE AND I UNDERSTAND THE LEGAL AND
FIDUCIARY DUTIES THAT I ASSUME BY ACTING OR AGREEING TO ACT AS THE AGENT
(ATTORNEY-IN-FACT) UNDER THE TERMS OF THIS POWER OF ATTORNEY.
(SIGNATURE OF AGENT)
(PRINT NAME OF AGENT)
THE POWERS YOU GRANT BELOW ARE EFFECTIVE
EVEN IF YOU BECOME DISABLED OR INCOMPETENT
NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING.
THEY ARE EXPLAINED IN THE UNIFORM STATUTORY FORM POWER OF ATTORNEY ACT.
IF YOU HAVE ANY QUESTIONS ABOUT THESE POWERS, OBTAIN COMPETENT LEGAL
ADVICE. THIS DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL AND
OTHER HEALTH-CARE DECISIONS FOR YOU. YOU MAY REVOKE THIS POWER OF
ATTORNEY IF YOU LATER WISH TO DO SO. THIS POWER OF ATTORNEY IS EFFECTIVE
IMMEDIATELY AND WILL CONTINUE TO BE EFFECTIVE EVEN IF YOU BECOME DISABLED,
INCAPACITATED, OR INCOMPETENT.
_____________________________________________ [insert your name and address] appoint
_____________________________________________ [insert the name and address of the
person appointed] as my Agent (attorney-in-fact) to act for me in any lawful way with respect to
the following initialed subjects:
TO GRANT ALL OF THE FOLLOWING POWERS, INITIAL THE LINE IN FRONT OF (N) AND
IGNORE THE LINES IN FRONT OF THE OTHER POWERS.
TO GRANT ONE OR MORE, BUT FEWER THAN ALL, OF THE FOLLOWING POWERS,
INITIAL THE LINE IN FRONT OF EACH POWER YOU ARE GRANTING.
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TO WITHHOLD A POWER, DO NOT INITIAL THE LINE IN FRONT OF IT. YOU MAY, BUT
NEED NOT, CROSS OUT EACH POWER WITHHELD.
Note: If you initial Item A or Item B, which follow, a notarized signature will be required on
behalf of the Principal.
_______ (A) Real property transactions. To lease, sell, mortgage, purchase, exchange, and
acquire, and to agree, bargain, and contract for the lease, sale, purchase, exchange, and
acquisition of, and to accept, take, receive, and possess any interest in real property whatsoever,
on such terms and conditions, and under such covenants, as my Agent shall deem proper; and to
maintain, repair, tear down, alter, rebuild, improve manage, insure, move, rent, lease, sell,
convey, subject to liens, mortgages, and security deeds, and in any way or manner deal with all
or any part of any interest in real property whatsoever, including specifically, but without limitation,
real property lying and being situated in the State of California, under such terms and conditions,
and under such covenants, as my Agent shall deem proper and may for all deferred payments
accept purchase money notes payable to me and secured by mortgages or deeds to secure debt,
and may from time to time collect and cancel any of said notes, mortgages, security interests, or
deeds to secure debt.
_______ (B) Tangible personal property transactions. To lease, sell, mortgage, purchase,
exchange, and acquire, and to agree, bargain, and contract for the lease, sale, purchase,
exchange, and acquisition of, and to accept, take, receive, and possess any personal property
whatsoever, tangible or intangible, or interest thereto, on such terms and conditions, and under
such covenants, as my Agent shall deem proper; and to maintain, repair, improve, manage,
insure, rent, lease, sell, convey, subject to liens or mortgages, or to take any other security
interests in said property which are recognized under the Uniform Commercial Code as adopted
at that time under the laws of the State of California or any applicable state, or otherwise
hypothecate (pledge), and in any way or manner deal with all or any part of any real or personal
property whatsoever, tangible or intangible, or any interest therein, that I own at the time of
execution or may thereafter acquire, under such terms and conditions, and under such
covenants, as my Agent shall deem proper.
_______ (C) Stock and bond transactions. To purchase, sell, exchange, surrender, assign,
redeem, vote at any meeting, or otherwise transfer any and all shares of stock, bonds, or other
securities in any business, association, corporation, partnership, or other legal entity, whether
private or public, now or hereafter belonging to me.
_______ (D) Commodity and option transactions. To organize or continue and conduct any
business which term includes, without limitation, any farming, manufacturing, service, mining,
retailing or other type of business operation in any form, whether as a proprietorship, joint
venture, partnership, corporation, trust or other legal entity; operate, buy, sell, expand, contract,
terminate or liquidate any business; direct, control, supervise, manage or participate in the
operation of any business and engage, compensate and discharge business managers,
employees, agents, attorneys, accountants and consultants; and, in general, exercise all powers
with respect to business interests and operations which the principal could if present and under
_______ (E) Banking and other financial institution transactions. To make, receive, sign,
endorse, execute, acknowledge, deliver and possess checks, drafts, bills of exchange, letters of
credit, notes, stock certificates, withdrawal receipts and deposit instruments relating to accounts
or deposits in, or certificates of deposit of banks, savings and loans, credit unions, or other
institutions or associations. To pay all sums of money, at any time or times, that may hereafter
be owing by me upon any account, bill of exchange, check, draft, purchase, contract, note, or
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trade acceptance made, executed, endorsed, accepted, and delivered by me or for me in my
name, by my Agent. To borrow from time to time such sums of money as my Agent may deem
proper and execute promissory notes, security deeds or agreements, financing statements, or
other security instruments in such form as the lender may request and renew said notes and
security instruments from time to time in whole or in part. To have free access at any time or
times to any safe deposit box or vault to which I might have access.
_______ (F) Business operating transactions. To conduct, engage in, and otherwise transact
the affairs of any and all lawful business ventures of whatever nature or kind that I may now or
hereafter be involved in.
_______ (G) Insurance and annuity transactions. To exercise or perform any act, power, duty,
right, or obligation, in regard to any contract of life, accident, health, disability, liability, or other
type of insurance or any combination of insurance; and to procure new or additional contracts of
insurance for me and to designate the beneficiary of same; provided, however, that my Agent
cannot designate himself or herself as beneficiary of any such insurance contracts.
_______ (H) Estate, trust, and other beneficiary transactions. To accept, receipt for,
exercise, release, reject, renounce, assign, disclaim, demand, sue for, claim and recover any
legacy, bequest, devise, gift or other property interest or payment due or payable to or for the
principal; assert any interest in and exercise any power over any trust, estate or property subject
to fiduciary control; establish a revocable trust solely for the benefit of the principal that terminates
at the death of the principal and is then distributable to the legal representative of the estate of
the principal; and, in general, exercise all powers with respect to estates and trusts which the
principal could exercise if present and under no disability; provided, however, that the Agent may
not make or change a will and may not revoke or amend a trust revocable or amendable by the
principal or require the trustee of any trust for the benefit of the principal to pay income or
principal to the Agent unless specific authority to that end is given.
_______ (I) Claims and litigation. To commence, prosecute, discontinue, or defend all actions
or other legal proceedings touching my property, real or personal, or any part thereof, or touching
any matter in which I or my property, real or personal, may be in any way concerned. To defend,
settle, adjust, make allowances, compound, submit to arbitration, and compromise all accounts,
reckonings, claims, and demands whatsoever that now are, or hereafter shall be, pending
between me and any person, firm, corporation, or other legal entity, in such manner and in all
respects as my Agent shall deem proper.
_______ (J) Personal and family maintenance. To hire accountants, attorneys at law,
consultants, clerks, physicians, nurses, agents, servants, workmen, and others and to remove
them, and to appoint others in their place, and to pay and allow the persons so employed such
salaries, wages, or other remunerations, as my Agent shall deem proper.
_______ (K) Benefits from Social Security, Medicare, Medicaid, or other governmental
programs, or military service. To prepare, sign and file any claim or application for Social
Security, unemployment or military service benefits; sue for, settle or abandon any claims to any
benefit or assistance under any federal, state, local or foreign statute or regulation; control,
deposit to any account, collect, receipt for, and take title to and hold all benefits under any Social
Security, unemployment, military service or other state, federal, local or foreign statute or
regulation; and, in general, exercise all powers with respect to Social Security, unemployment,
military service, and governmental benefits, including but not limited to Medicare and Medicaid,
which the principal could exercise if present and under no disability.
_______ (L) Retirement plan transactions. To contribute to, withdraw from and deposit funds
in any type of retirement plan (which term includes, without limitation, any tax qualified or
nonqualified pension, profit sharing, stock bonus, employee savings and other retirement plan,
individual retirement account, deferred compensation plan and any other type of employee
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benefit plan); select and change payment options for the principal under any retirement plan;
make rollover contributions from any retirement plan to other retirement plans or individual
retirement accounts; exercise all investment powers available under any type of self-directed
retirement plan; and, in general, exercise all powers with respect to retirement plans and
retirement plan account balances which the principal could if present and under no disability.
_______ (M) Tax matters. To prepare, to make elections, to execute and to file all tax, social
security, unemployment insurance, and informational returns required by the laws of the United
States, or of any state or subdivision thereof, or of any foreign government; to prepare, to
execute, and to file all other papers and instruments which the Agent shall think to be desirable or
necessary for safeguarding of me against excess or illegal taxation or against penalties imposed
for claimed violation of any law or other governmental regulation; and to pay, to compromise, or
to contest or to apply for refunds in connection with any taxes or assessments for which I am or
may be liable.
_______ (N) ALL OF THE POWERS LISTED ABOVE. YOU NEED NOT INITIAL ANY OTHER
LINES IF YOU INITIAL LINE (N).
ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS LIMITING OR
EXTENDING THE POWERS GRANTED TO YOUR AGENT.
THIS POWER OF ATTORNEY IS EFFECTIVE IMMEDIATELY AND WILL CONTINUE UNTIL IT
THIS POWER OF ATTORNEY SHALL BE CONSTRUED AS A GENERAL DURABLE POWER
OF ATTORNEY AND SHALL CONTINUE TO BE EFFECTIVE EVEN IF I BECOME DISABLED,
INCAPACITATED, OR INCOMPETENT.
(YOUR AGENT WILL HAVE AUTHORITY TO EMPLOY OTHER PERSONS AS NECESSARY
TO ENABLE THE AGENT TO PROPERLY EXERCISE THE POWERS GRANTED IN THIS
FORM, BUT YOUR AGENT WILL HAVE TO MAKE ALL DISCRETIONARY DECISIONS. IF YOU
WANT TO GIVE YOUR AGENT THE RIGHT TO DELEGATE DISCRETIONARY DECISION-
MAKING POWERS TO OTHERS, YOU SHOULD KEEP THE NEXT SENTENCE, OTHERWISE
IT SHOULD BE STRICKEN.)
Authority to Delegate. My Agent shall have the right by written instrument to delegate any or all
of the foregoing powers involving discretionary decision-making to any person or persons whom
my Agent may select, but such delegation may be amended or revoked by any agent (including
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any successor) named by me who is acting under this power of attorney at the time of reference.
(YOUR AGENT WILL BE ENTITLED TO REIMBURSEMENT FOR ALL REASONABLE
EXPENSES INCURRED IN ACTING UNDER THIS POWER OF ATTORNEY. STRIKE OUT THE
NEXT SENTENCE IF YOU DO NOT WANT YOUR AGENT TO ALSO BE ENTITLED TO
REASONABLE COMPENSATION FOR SERVICES AS AGENT.)
Right to Compensation. My Agent shall be entitled to reasonable compensation for services
rendered as agent under this power of attorney.
(IF YOU WISH TO NAME SUCCESSOR AGENTS, INSERT THE NAME(S) AND ADDRESS(ES)
OF SUCH SUCCESSOR(S) IN THE FOLLOWING PARAGRAPH.)
Successor Agent. If any Agent named by me shall die, become incompetent, resign or refuse to
accept the office of Agent, I name the following (each to act alone and successively, in the order
named) as successor(s) to such Agent:
Choice of Law. THIS POWER OF ATTORNEY WILL BE GOVERNED BY THE LAWS OF THE
STATE OF CALIFORNIA WITHOUT REGARD FOR CONFLICTS OF LAWS PRINCIPLES. IT
WAS EXECUTED IN THE STATE OF CALIFORNIA AND IS INTENDED TO BE VALID IN ALL
JURISDICTIONS OF THE UNITED STATES OF AMERICA AND ALL FOREIGN NATIONS.
I am fully informed as to all the contents of this form and understand the full import of this grant of
powers to my Agent.
I agree that any third party who receives a copy of this document may act under it. Revocation of
the power of attorney is not effective as to a third party until the third party learns of the
revocation. I agree to indemnify the third party for any claims that arise against the third party
because of reliance on this power of attorney.
Signed this _______ day of _______________, 20____
[Your Social Security Number]
CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC
STATE OF CALIFORNIA
COUNTY OF ________________
This document was acknowledged before me on _______________ [Date] by
________________________________________________ [name of principal].
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[Notary Seal, if any]:
(Signature of Notarial Officer)
Notary Public for the State of California
My commission expires: ___________________
ACKNOWLEDGMENT OF AGENT
BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT ASSUMES THE
FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES OF AN AGENT.
[Typed or Printed Name of Agent]
[Signature of Agent]
This document was prepared by the following individual:
[Typed or Printed Name]