Limited Power of Attorney - Pennsylvania

LIMITED POWER OF ATTORNEY (PENNSYLVANIA)

NOTICE

THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU.

THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS, BUT, WHEN POWERS ARE EXERCISED, YOUR AGENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY.

YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME INCAPACITATED, UNLESS YOU EXPRESSLY LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY.

YOUR AGENT MUST ACT IN ACCORDANCE WITH YOUR REASONABLE EXPECTATIONS TO THE EXTENT ACTUALLY KNOWN BY YOUR AGENT AND, OTHERWISE, IN YOUR BEST INTEREST, ACT IN GOOD FAITH AND ACT ONLY WITHIN THE SCOPE OF AUTHORITY GRANTED BY YOU IN THE POWER OF ATTORNEY.

THE LAW PERMITS YOU, IF YOU CHOOSE, TO GRANT BROAD AUTHORITY TO AN AGENT UNDER POWER OF ATTORNEY, INCLUDING THE ABILITY TO GIVE AWAY ALL OF YOUR PROPERTY WHILE YOU ARE ALIVE OR TO SUBSTANTIALLY CHANGE HOW YOUR PROPERTY IS DISTRIBUTED AT YOUR DEATH. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD SEEK THE ADVICE OF AN ATTORNEY AT LAW TO MAKE SURE YOU UNDERSTAND IT.

A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR AGENT IS NOT ACTING PROPERLY.

THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY ARE EXPLAINED MORE FULLY IN 20 PA.C.S. CH. 56.

IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU.

I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE AND I UNDERSTAND ITS CONTENTS.

Principal's signature for Notice: ____________________________________ Date: [__/__/____]

One designated payment

Before signing: Complete the account, recipient, exact obligation, amount ceiling, destination, and expiration. This form grants authority for one payment and no real-estate transaction. A land use requires a separately drafted power and review of recording in the counties identified by 20 Pa.C.S. § 5602(c).

I, [PRINCIPAL FULL LEGAL NAME], of [ADDRESS], appoint [AGENT FULL LEGAL NAME], of [ADDRESS], as my agent only for the payment written below.

Financial institution and account: [INSTITUTION; ACCOUNT TYPE AND LAST FOUR DIGITS]

Recipient: [RECIPIENT'S FULL LEGAL NAME AND ADDRESS]

Obligation being paid: [SPECIFIC INVOICE, CONTRACT, OR OTHER IDENTIFIER]

Maximum payment including fees: $[AMOUNT]

Permitted payment method and destination: [METHOD AND RECIPIENT ACCOUNT OR DELIVERY ADDRESS]

My agent may ask the institution for the balance needed to confirm the payment, sign one instruction in my name to pay the stated obligation within the ceiling, receive the confirmation, and give me the receipt. The agent may not divide the payment to exceed the ceiling, choose a different recipient, incur debt, change an account, or use the funds for personal benefit. An unfilled material field gives the agent no authority to decide that term.

No general grant of all acts or general banking authority is made. This power does not grant authority to make gifts; change a trust, beneficiary designation, or survivorship right; delegate authority; waive a survivor annuity; exercise fiduciary powers; disclaim property; access electronic-communication content; sell land; make health-care decisions; or make or alter my will. None of the nine authorities listed in 20 Pa.C.S. § 5601.4(a) is granted.

Duration and duties

This power becomes effective when the required principal execution is complete. The agent may not act until signing the acknowledgment below. The power is durable and remains exercisable if I later become disabled or incapacitated under 20 Pa.C.S. §§ 5601.1 and 5604(a). It ends after this one payment or at [TIME] on [EXPIRATION DATE], whichever occurs first, and may end sooner under law. My agent must stop acting when authority ends.

When acting, my agent must follow my reasonable expectations to the extent actually known and otherwise act in my best interest, act in good faith, and stay within this grant. The agent must keep the instruction and receipt and provide copies on request.

Principal's execution

I date and sign this limited power of attorney on [__/__/____] at [CITY, PENNSYLVANIA].

Principal's signature: ____________________________________

Printed name: [PRINCIPAL FULL LEGAL NAME]

The two witnesses must each be at least 18 years old. Neither witness may be the named agent, the person signing for the principal, or the officer taking the acknowledgment.

Witness 1 signature: ____________________________________ Date: [__/__/____]

Witness 1 printed name and address: [________________________________]

Witness 2 signature: ____________________________________ Date: [__/__/____]

Witness 2 printed name and address: [________________________________]

Acknowledgment

Commonwealth of Pennsylvania, County of [COUNTY]. This record was acknowledged before me on [__/__/____] by [PRINCIPAL FULL LEGAL NAME].

Notarial officer's signature: ____________________________________

Printed name and title: [________________________________] Official stamp: [STAMP]

Commission expires: [__/__/____]

Agent acknowledgment

I, [AGENT FULL LEGAL NAME], have read the attached power of attorney and am the person identified as the agent for the principal. I hereby acknowledge that when I act as agent:

I shall act in accordance with the principal's reasonable expectations to the extent actually known by me and, otherwise, in the principal's best interest, act in good faith and act only within the scope of authority granted to me by the principal in the power of attorney.

Agent's signature: ____________________________________ Date: [__/__/____]

Sources and References

• Pennsylvania General Assembly, 20 Pa.C.S. chapter 56.