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    Fpoa 2012

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    Anthony Juice Gaston Bey
    ______________________________ Nominee’s Address: _________________________________________________________ Nominee’s Telephone Number: ( State of Ohio ‐ Statutory Form Power of Attorney ) ___________________________________ 4 | P a g e 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. SIGNATURE AND ACKNOWLEDGMENT Your Signature ______________________________________ Date _________________ Your Name Printed: ________________________________________________________ Your Address: _____________________________________________________________ Your Telephone Number: ( )

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    © All Rights Reserved
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    Fpoa 2012

    Uploaded by

    Anthony Juice Gaston Bey
    80 views9 pages
    ______________________________ Nominee’s Address: _________________________________________________________ Nominee’s Telephone Number: ( State of Ohio ‐ Statutory Form Power of Attorney ) ___________________________________ 4 | P a g e 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. SIGNATURE AND ACKNOWLEDGMENT Your Signature ______________________________________ Date _________________ Your Name Printed: ________________________________________________________ Your Address: _____________________________________________________________ Your Telephone Number: ( )

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    FPOA

    Original Title

    FPOA-2012

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    ______________________________ Nominee’s Address: _________________________________________________________ Nominee’s Telephone Number: ( State of Ohio ‐ Statutory Form Power of Attorney ) ___________________________________ 4 | P a g e 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. SIGNATURE AND ACKNOWLEDGMENT Your Signature ______________________________________ Date _________________ Your Name Printed: ________________________________________________________ Your Address: _____________________________________________________________ Your Telephone Number: ( )

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    80 views9 pages

    Fpoa 2012

    Uploaded by

    Anthony Juice Gaston Bey
    ______________________________ Nominee’s Address: _________________________________________________________ Nominee’s Telephone Number: ( State of Ohio ‐ Statutory Form Power of Attorney ) ___________________________________ 4 | P a g e 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. SIGNATURE AND ACKNOWLEDGMENT Your Signature ______________________________________ Date _________________ Your Name Printed: ________________________________________________________ Your Address: _____________________________________________________________ Your Telephone Number: ( )

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 9

    STATE OF OHIO

    STATUTORY FORM POWER OF ATTORNEY


    COVER LETTER
    See the Important Information section in the attached document. After reviewing the
    contents of this packet, you may have additional questions or concerns specific to your
    personal situation. In such a case, it is important that you discuss your concerns with
    your family and your lawyer. If you are an Ohio resident age 60 or older, you may call
    the Pro Seniors Senior Legal Helpline at 1-800-488-6070 to schedule a free telephone
    appointment for legal advice.
    WARNING
    Under Ohio law, it is a crime to unlawfully or improperly use an adults resources for
    monetary or personal benefit, profit, or gain without the adults consent. The law may
    further require that any person having knowledge of such abuse, neglect or exploitation
    of a person age 60 or older report that information to the county office of Adult
    Protective Services.

    SUBJECTS TO INCLUDE IN YOUR AGENTS GENERAL AUTHORITY


    To give your agent general authority to act for you with respect to the subjects listed
    below, you must also write your INITIALS on the form, on the line to the left of each
    subject to include in your agent's general authority. You must initial the subjects you
    chose to give to your agent on the form prior to signing the form.
    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
    Generally in order for your agent to exercise authority over these subjects, you must also
    write your INITIALS on the form, on the line to the left of each subject to include in your
    agent's general authority. However, if you chose to give your agent authority over all the
    subjects listed, instead of initialing each subject, you may simply write your INITIALS
    on the form, on the line to the left of "All Preceding Subjects" at the bottom of the subject
    list on the form prior to signing the form.
    _______________________________________________________________________
    Ohio Statutory Form Power Of Attorney Cover Letter

    1|Page

    SIGNING AND RECORDING THE FORM


    In order for this form to be used in connection with real property transactions, you must
    sign and acknowledge the form before a notary public and the form must also be recorded
    in the office of the county recorder of the county in which the real property is located
    prior to using the form in connection with a real property transaction. (R.C. 1337.04).
    Another benefit to signing and acknowledging the form before a notary public is that
    your signature on the statutory form power of attorney is presumed to be genuine if you
    acknowledge your signature before a notary public and this will greatly facilitate the
    forms acceptance by businesses, banks and other financial institutions. (R.C. 1337.25).
    Note that recording the completed statutory form power of attorney in the office of the
    county recorder is permitted but not required unless the form will be used in connection
    with a real estate transaction. The recording and indexing fees set by the Ohio Revised
    Code (R.C. 317.32) are twenty-eight dollars for the first two pages and eight dollars for
    each additional page.

    _______________________________________________________________________
    Ohio Statutory Form Power Of Attorney Cover Letter

    2|Page

    STATE OF OHIO
    STATUTORY FORM POWER OF ATTORNEY
    IMPORTANT INFORMATION
    1) 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).
    2) This power of attorney does not authorize the agent to make health-care decisions for
    you.
    3) 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.
    4) Your agent is entitled to reasonable compensation unless you state otherwise in the
    Special Instructions.
    5) 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.
    6) 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.
    7) 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;
    (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.
    StateofOhioStatutoryFormPowerofAttorney

    1|P a g e

    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.

    STATE OF OHIO
    STATUTORY FORM POWER OF ATTORNEY
    DESIGNATION OF AGENT
    I, _________________________________________________ name the following
    person as my agent:
    Name of Agent: ____________________________________________________________
    Agents Address: ___________________________________________________________
    Agents 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: ___________________________________________________
    Successor Agents Address: __________________________________________________
    Successor Agents Telephone Number: (

    ) ____________________________

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


    successor agent:
    Name of Second Successor Agent: _____________________________________________
    Second Successor Agents Address: ____________________________________________
    Second Successor Agents Telephone Number: (

    StateofOhioStatutoryFormPowerofAttorney

    ) ______________________

    2|P a g e

    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.

    StateofOhioStatutoryFormPowerofAttorney

    3|P a g e

    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: _____________________________________
    Nominees Address: _________________________________________________________
    Nominees Telephone Number: (

    ) ___________________________________

    Name of Nominee for guardian of my person: _____________________________________


    Nominees Address: _________________________________________________________
    Nominees Telephone Number: (

    StateofOhioStatutoryFormPowerofAttorney

    ) ___________________________________

    4|P a g e

    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.

    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 __________________________ (Date), by
    __________________________________________________________ (Name of Principal).
    _________________________________________
    Signature of Notary
    My commission expires: ______________________________________________________

    This document prepared by:


    _________________________________________
    _________________________________________
    _________________________________________
    _________________________________________

    StateofOhioStatutoryFormPowerofAttorney

    5|P a g e

    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.

    StateofOhioStatutoryFormPowerofAttorney

    6|P a g e

    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.

    StateofOhioStatutoryFormPowerofAttorney

    7|P a g e

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