New York Durable Power of Attorney Template
This Durable Power of Attorney is established in accordance with the New York General Obligations Law (Article 5, Title 15) and authorizes the person named below as the Agent to make decisions and act on behalf of the Principal. By this document, the Principal intends for the authority of the Agent to continue even in the event of the Principal’s subsequent incapacity.
1. Principal Information
Name: ___________________________________________
Address: ___________________________________________
City, State, Zip: ___________________________________________
Contact Number: ___________________________________________
2. Agent Information
Name: ___________________________________________
Address: ___________________________________________
City, State, Zip: ___________________________________________
Contact Number: ___________________________________________
3. Successor Agent Information (Optional)
If the initial Agent is unable, unwilling or unavailable to serve, the Principal nominates the following person as successor Agent:
Name: ___________________________________________
Address: ___________________________________________
City, State, Zip: ___________________________________________
Contact Number: ___________________________________________
4. Powers Granted
The Agent is granted full authority to act on the Principal's behalf in all matters concerning the Principal's personal and financial affairs, including but not limited to:
- Real property transactions
- Banking and financial transactions
- Insurance and annuity transactions
- Benefit from Social Security, Medicare, or other governmental programs, or military service
- Tax matters
- Health care decisions, including access to medical records
This power of attorney does not authorize the Agent to make health care decisions.
5. Special Instructions (Optional)
The Principal may set forth any specific limitations on the Agent's authority or any specific instructions regarding decisions and actions that the Agent is authorized to make on the Principal’s behalf:
________________________________________________________________
________________________________________________________________
6. Execution
This Power of Attorney must be dated and signed by the Principal in the presence of a notary public or two witnesses, neither of whom is the Agent or the Successor Agent.
Date: ___________________________________________
Principal’s Signature: ___________________________________________
State of New York, County of _______________________________:
Subscribed and sworn to before me on this ____ day of __________, 20____.
Notary Public: ___________________________________________
(Notary Seal)
7. Acceptance by Agent
By signing below, the Agent named above accepts this appointment and agrees to act and serve to the best of their abilities, in good faith, under the terms set forth herein, and within all applicable laws of the State of New York.
Date: ___________________________________________
Agent’s Signature: ___________________________________________
Successor Agent’s Signature (if applicable): ___________________________________________
This document is intended to be a Durable Power of Attorney and shall continue to be effective in the event of the Principal's incapacity.
Note: This form does not provide for decision-making authority over health care matters. For health care matters, it is recommended to complete a New York Health Care Proxy Form.