Laserfiche WebLink
<br />. ' Statutory Durable Power of Attorney Fonn <br /> <br />loo~1 <br /> <br />Page 2 of3 <br /> <br />~~~3 :m..social security, Merli~~rp. Medicaid, er oM1\..j ~uvl;;nunt:mal programs or C1VlI or mtlil(11)' <br />S::PM'lt;:e, - <br /> <br />RetifElm.'-llt ylcul hM3aetieR!, <br /> <br />Tax matters. <br /> <br />IF NO POWER LISTED ABOVE IS CROSSED OUT, THIS DOCUMENT SHALL BE CONSTRUED <br />AND INTERPRETED AS A GENERAL POWER OF ATTORNEY AND MY AGENT (ATTORNEY <br />IN FACT) SHALL HAVE THE POWER AND AUTHORITY TO PERFORM OR UNDERTAKE <br />ANY ACTION I COULD PERFORM OR UNDERTAKE IF I WERE PERSONALLY PRESENT. <br /> <br />SPECIAL INSTRUCTIONS: <br /> <br />Special instructions applicable to gifts (initial in front of the following sentence to have it apply): <br /> <br />I grant my agent (attorney in fact) the power to apply my property to make gifts, except that the amount <br />of a gift to an individual may not exceed the amount of annual exclusions allowed from the federal gift <br />tax for the calendar year of the gift. . <br /> <br />ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS LIMITING OR <br />EXTENDING THE POWERS GRANTED TO YOUR AGENT. <br /> <br />P~1 ~ ir"-.J.~d~J -h ,"",c.lKdL. Y"'\Jf.e.,.,.J YG.1d'-r f" #...- <br /> <br />I~~, seJ~ t ~nL,' D;,p.#~IrY<--/ ~1A.{,ktf ~"~,/$' ~)~'Q-I-o <br /> <br />,.....V't..s~ / vv......fJ ~e..,..t,'t:.1 ,'lIO. L~n,..>v- C~~v, Tx <br /> <br />UNLESS YOU DIRECT OTHERWISE ABOVE, THIS POWER OF ATTORNEY IS EFFECTIVE <br />IMMEDIATEL Y AND WILL CONTINUE UNTIL IT IS REVOKED. <br /> <br />CHOOSE ONE OF THE FOLLOWING ALTERNATIVES BY CROSSING OUT THE <br />ALTERNATIVE NOT CHOSEN: <br /> <br />(A) This power of attorney is not affected by my subsequent disability or incapacity. <br /> <br />~) This ~bccomc;s cffceth'e upcm my Eli!:3bility or ;"('~p~('ity._ <br /> <br />YOU SHOULD CHOOSE ALTERNATIVE (A) IF THIS POWER OF ATTORNEY IS TO BECOME <br />EFFECTIVE ON THE DATE IT IS EXECUTED. <br /> <br />IF NEITHER (A) NOR (B) IS CROSSED OUT, IT WILL BE ASSUMED THAT YOU CHOSE <br />ALTERNATIVE (A). <br /> <br />If Alternative (B) is chosen and a definition of my disability or incapacity is not contained in this power <br />of attorney, I shall be considered disabled or incapacitated for purposes of this power of attorney if a <br />physician certifies in writing at a date later than the date this power of attorney is executed that, based on <br />the physician's medical examination of me, I am mentally incapable of managing my financial affairs. I <br />authorize the physician who examines me for this purpose to disclose my physical or mental condition to <br /> <br />http://www.texasprobate.com/formslpoa.htm <br /> <br />RP 1116fAGE0162 <br /> <br />9/17/2001 <br /> <br />-r- <br />