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Uniform Statutory Form Power of Attorney (California Probate Code Section 4401)

In accordance with the State of California Probate Code Act of 4401, any person who is able to execute a Uniform Statutory Form Power of Attorney and to appoint any attorney or agent for their individual lawful acts with respect to any powers as provided in that place, except for making decisions of medical nature or related to healthcare.

 

Pursuant to the California Probate Code Act of 4401, anyone can execute a Uniform Statutory Form Power of Attorney appointing any agent or attorney-in-fact to do for the individual’s lawful acts with respect to any powers as provided therein, except to make medical and other health care decisions. Download

Extracted Text for Proper Search

Uniform Statutory Form Power of  Attorney	
(California Probate Code Section 4401)	
NOTICE: The powers granted by this document are broad and sweeping. They are explained in the Uni	-	
form Statutory Form Power of  Attorney Act (California Probate Code sections 4400-4465). 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.	
I ___________________________________________________________________
       	          	(your name and address)	
appoint _____________________________________________________________
 	 (name and address of the person appointed, or of each person appointed if you want to designate more than one)	
as my agent (attorney-in-fact) to act for me in any lawful way with respect to the 
following initialed subjects:
INITIAL
____ (A)   Real property transactions.
____ (B)   Tangible personal property transactions.
____ (C)    Stock and bond transactions.
____ (D)   Commodity and option transactions.
____ (E)   Banking and other financial institution transactions.
____ (F)   Business operating transactions.
____ (G)   Insurance and annuity transactions.
____ (H)   Estate, trust, and other beneficiary transactions.
____ (I)    Claims and litigation.
____ (J)    Personal and family maintenance.
____ (K)   Benefits from social secuirty, medicare, medicaid, or other governmental 
 	       programs, or civil or military service.	
____ (L)    Retirement plan transactions.
____ (M)   Tax matters.
____ (N)   ALL OF THE POWERS LISTED ABOVE.
You need not initial any other lines if  you initial line (N).	
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 of  the 
powers you are granting.
To withhold a power, do not initial the line in front of  it. You may, but need not, cross out each power with	-	
held.	
(Continued on Reverse)

Special Instructions:	
On the following lines, you may give special instructions limiting or extending the powers granted to your 
agent.
 	_____________________________________________________________________________	
 	_____________________________________________________________________________	
 	_____________________________________________________________________________	
 	_____________________________________________________________________________	
 	_____________________________________________________________________________	
 	_____________________________________________________________________________	
 	_____________________________________________________________________________	 	
Unless you direct otherwise above, this power of  attorney is effective immediately and will continue until it 
is revoked.
 	This power of  attorney will continue to be effective even though I become incapacitated.	
Strike the preceding sentence if  you do not want this power of  attorney to continue if  you become incapaci	-	
tated.	
Exercise of  power of  attorney where more than one agent designated	
 	If  I have designated more than one agent, the agents are to act	
 	___________________________________________________________________	
If  you appointed more than one agent and you want each agent to be able to act alone without the other 
agent koining, write the word “separately” in the blank space above. If  you do not insert any word in the 
blank space, or if  you insert the word “jointly”, then all of  your agents must act or sign together.
 
 	I agree that any third party who receives a copy of  this document may act under 	
 	it. A third party may seek identification. Revocation of  the power of  attorney is 	
 	not effective as to a third party until the third party has actual knowledge of  the 	
 	revocation. I agree to the indemnity of  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 signature)	
By accepting or acting under the appointment, the agent assumes the fiduciary and other legal 
responsibilities of  an agent.
[Include certificate of  acknowledgement of  notary public in compliance with 1189 of  the Civil Code or other applicable law.]

State of  California
County of  __________________
On ___________________________________________ before me,  ________________________________
                 	          	(here insert name and title of the officer)	
personally appeared ________________________________________, who proved to me on the basis of  
satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and ac	-	
knowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by 
his/her/their signature(s) on the instrument the person(s), or the entity upon behalf  of  which the person(s) 
acted, executed the instrument.
I certify under the PENALTY OF PERJURY under the laws of  the State of  California that the foregoing 
paragraph is true and correct.
WITNESS my hand and official seal.
Signature ________________________________	   	    	(SEAL)
Next: US A0 136A, Certificate of Good Standing (Court of Appeals) Previous: Uniform Request and Cancellation Affidavit
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