Power Of Attorney - New York Statutory Short Form Page 8
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9New York State Bar Association
New York Statutory Short Form Power of Attorney, 8/18/10, Eff. 9/12/10
distributed at your death. If you wish to authorize your agent to make gifts to himself or herself,
you must separately grant that authority in subdivision (c) below.
(______) I grant the following authority to my agent to make gifts pursuant to my instructions, or
otherwise for purposes which the agent reasonably deems to be in my best interest:
(c)
GRANT OF SPECIFIC AUTHORITY FOR AN AGENT TO MAKE GIFTS TO HIMSELF OR
HERSELF: (OPTIONAL)
If you wish to authorize your agent to make gifts to himself or herself, you must grant that
authority in this section, indicating to which agent(s) the authorization is granted, and any
limitations and guidelines.
(______) I grant specific authority for the following agent(s) to make the following gifts to himself
or herself:
This authority must be exercised pursuant to my instructions, or otherwise for purposes which the
agent reasonably deems to be in my best interest.
(d)
ACCEPTANCE BY THIRD PARTIES:
I agree to indemnify the third party for any claims that may arise against the third party
because of reliance on this Statutory Gifts Rider.
(e)
SIGNATURE OF PRINCIPAL AND ACKNOWLEDGMENT:
In Witness Whereof I have hereunto signed my name on __________, 20__.
PRINCIPAL signs here: ====>
______________________________________
STATE OF NEW YORK
)
)
ss:
COUNTY OF _________ )
On the ____ day of __________, 20__, before me, the undersigned, personally appeared
____________________, personally known to me or proved to me on the basis of satisfactory
evidence to be the individual whose name is subscribed to the within instrument and
acknowledged to me that he/she executed the same in her/his capacity, and that by her/his
signature on the instrument, the individual, or the person upon behalf of which the individual
acted, executed the instrument.
___________________________________
Notary Public
2010 N.Y. Laws ch. 340
Page 8 of 9
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