FormDownload Logo

Free Ohio Statutory Power of Attorney Form - PDF Form Download

Ohio Statutory Power of Attorney Form Overall rating: ☆☆☆☆☆ 0 based on 0 reviews
5 1

This power of attorney authorizes another person (your agent) to make decisions concerning your property for you. Your agent will be able to make  decisions and act with respect to your property (including your money) whether or not you are able to act for yourself.


Ohio Statutory Power of Attorney Form

Text Version of this Form

———————– Page 1———————–

STATE OF OHIO

STATUTORY FORM POWER OF ATTORNEY

IMPORTANT INFORMATION

This power of attorney authorizes another person (your agent) to make decisions
concerning your property for you (the principal). Your agent will be able to make
decisions and act with respect to your property (including your money) whether or not
you are able to act for yourself. The meaning of authority over subjects listed on this
form is explained in the Uniform Power of Attorney Act (sections 1337.21 to 1337.64 of
the Revised Code).

This power of attorney does not authorize the agent to make health-care decisions for
you. You should select someone you trust to serve as your agent. Unless you specify
otherwise, generally the agent’s authority will continue until you die or revoke the power
of attorney or the agent resigns or is unable to act for you.

Your agent is entitled to reasonable compensation unless you state otherwise in the
Special Instructions.

This form provides for designation of one agent. If you wish to name more than one
agent you may name a coagent in the Special Instructions. Coagents are not required to
act together unless you include that requirement in the Special Instructions.

If your agent is unable or unwilling to act for you, your power of attorney will end unless
you have named a successor agent. You may also name a second successor agent.

This power of attorney becomes effective immediately unless you state otherwise in the
Special Instructions.

ACTIONS REQUIRING EXPRESS AUTHORITY

Unless expressly authorized and initialed by me in the Special Instructions, this power of
attorney does not grant authority to my agent to do any of the following:

(1) Create a trust;

(2) Amend, revoke, or terminate an inter vivos trust, even if specific authority to do so is
granted to the agent in the trust agreement;

(3) Make a gift;

(4) Create or change rights of survivorship;

(5) Create or change a beneficiary designation;

———————– Page 2———————–

(6) Delegate authority granted under the power of attorney;

(7) Waive the principal’s right to be a beneficiary of a joint and survivor annuity,
including a survivor benefit under a retirement plan;

(8) Exercise fiduciary powers that the principal has authority to delegate.

CAUTION: Granting any of the above eight powers will give your agent the
authority to take actions that could significantly reduce your property or change
how your property is distributed at your death.

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.

DESIGNATION OF AGENT

I, __________________________ name the following person as my agent:

Name of Agent:

Agent’s Address:

Agent’s Telephone Number:

DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)

If my agent is unable or unwilling to act for me, I name as my successor agent:

Name of Successor Agent:

Address of Successor Agent:

Phone Number of Successor Agent:

If my successor agent is unable or unwilling to act for me, I name as my second successor
agent:

Name of Second Successor Agent:

Address of Second Successor Agent:

Phone Number of Second Successor Agent:

———————– Page 3———————–

GRANT OF GENERAL AUTHORITY

I grant my agent and any successor agent general authority to act for me with respect to
the following subjects as defined in the Uniform Power of Attorney Act (sections
1337.21 to 1337.64 of the Revised Code):

(INITIAL each subject you want to include in the agent’s general authority. If you wish
to grant general authority over all of the subjects you may initial “All Preceding Subjects”
instead of initialing each subject.)

(……) Real Property

(……) Tangible Personal Property

(……) Stocks and Bonds

(……) Commodities and Options

(……) Banks and Other Financial Institutions

(……) Operation of Entity or Business

(……) Insurance and Annuities

(……) Estates, Trusts, and Other Beneficial Interests

(……) Claims and Litigation
(……) Personal and Family Maintenance

(……) Benefits from Governmental Programs or Civil or Military Service
(……) Retirement Plans
(……) Taxes

(……) All Preceding Subjects

LIMITATION ON AGENT’S AUTHORITY

An agent that is not my ancestor, spouse, or descendant MAY NOT use my property to
benefit the agent or a person to whom the agent owes an obligation of support unless I
have included that authority in the Special Instructions.

———————– Page 4———————–

SPECIAL INSTRUCTIONS (OPTIONAL)

You may give special instructions on the following lines:

__________________________________________________________________ _____

________________________________________________________________________

EFFECTIVE DATE

This power of attorney is effective immediately unless I have stated otherwise in the
Special Instructions.

NOMINATION OF GUARDIAN (OPTIONAL)

If it becomes necessary for a court to appoint a guardian of my estate or my person, I
nominate the following person(s) for appointment

Name of Nominee for guardian of my estate:

Nominee’s Address:

Nominee’s Telephone Number:

Name of Nominee for guardian of my person:

Nominee’s Address:

Nominee’s Telephone Number:

RELIANCE ON THIS POWER OF ATTORNEY

Any person, including my agent, may rely upon the validity of this power of attorney or a
copy of it unless that person knows it has terminated or is invalid.

———————– Page 5———————–

SIGNATURE AND ACKNOWLEDGMENT

Your Signature Date

Your Name Printed

Your Address

Your Telephone Number

State of Ohio

County of ……………………..

This document was acknowledged before me on ………………………, 201__, by

………………………………………………….

_____________________________________
Signature of Notary

My Commission expires: ________________________

———————– Page 6———————–

IMPORTANT INFORMATION FOR AGENT

Agent’s Duties
When you accept the authority granted under this power of attorney, a special legal
relationship is created between you and the principal. This relationship imposes upon you
legal duties that continue until you resign or the power of attorney is terminated or
revoked. You must:

(1) Do what you know the principal reasonably expects you to do with the principal’s
property or, if you do not know the principal’s expectations, act in the principal’s best
interest;

(2) Act in good faith;

(3) Do nothing beyond the authority granted in this power of attorney;

(4) Attempt to preserve the principal’s estate plan if you know the plan and preserving the
plan is consistent with the principal’s best interest;

(5) 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 Signature) as Agent

Unless the Special Instructions in this power of attorney state otherwise, you must also:

(1) Act loyally for the principal’s benefit;

(2) Avoid conflicts that would impair your ability to act in the principal’s best interest;

(3) Act with care, competence, and diligence;

(4) Keep a record of all receipts, disbursements, and transactions made on behalf of the
principal;

(5) Cooperate with any person that has authority to make health-care decisions for the
principal to do what you know the principal reasonably expects or, if you do not know
the principal’s expectations, to act in the principal’s best interest.

———————– Page 7———————–

Termination of Agent’s Authority

You must stop 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. Events that
terminate a power of attorney or your authority to act under a power of attorney include:

(1) The death of the principal;

(2) The principal’s revocation of the power of attorney or your authority;

(3) The occurrence of a termination event stated in the power of attorney;

(4) The purpose of the power of attorney is fully accomplished;

(5) If you are married to the principal, a legal action is filed with a court to end your
marriage, or for your legal separation, unless the Special Instructions in this power of
attorney state that such an action will not terminate your authority.

Liability of Agent

The meaning of the authority granted to you is defined in the Uniform Power of Attorney
Act (sections 1337.21 to 1337.64 of the Revised Code). If you violate the Uniform Power
of Attorney Act or act outside the authority granted, you may be liable for any damages
caused by your violation.

If there is anything about this document or your duties that you do not understand, you
should seek legal advice.

———————– Page 8———————–

AGENT’S CERTIFICATION AS TO THE VALIDITY OF POWER OF ATTORNEY
AND AGENT’S AUTHORITY

State of Ohio

County of …………………

I, ………………………………….. (Name of Agent), certify under penalty of perjury that
……………………….. (Name of Principal) granted me authority as an agent or successor
agent in a power of attorney dated …………………………..

I further certify that to my knowledge:

(1) The Principal is alive and has not revoked the Power of Attorney or my authority to
act under the Power of Attorney and the Power of Attorney and my authority to act under
the Power of Attorney have not terminated;

(2) If the Power of Attorney was drafted to become effective upon the happening of an
event or contingency, the event or contingency has occurred;

(3) If I was named as a successor agent, the prior agent is no longer able or willing to
serve;

(4) (Insert any other relevant statements)

SIGNATURE AND ACKNOWLEDGMENT

Agent’s Signature Date

Agent’s Name Printed

Agent’s Address

Agent’s Telephone Number

———————– Page 9———————–

State of Ohio

County of ……………………..

This document was acknowledged before me on …………………., (Date) by

____________________________________ (Name of Agent).

__________________________________________
Notary Public

My commission expires:

Ohio Statutory Power of Attorney Form Reviews

Review this Form

Name
Email
Rating
Review