Kentucky Health Care Power Of Attorney Form printable pdf download

THIS IS A FORM OF LEGAL DOCUMENT.

LEGAL OR OTHER PROFESSIONAL COUNSEL

SHOULD BE CONSULTED BEFORE SIGNING.

DURABLE POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENT, that I, ______________________________________________,

Social Security Number ___________________________, of ____________________ County, Kentucky,

revoke

all

powers

attorney

made

me,

and

hereby

constitute

and

appoint________________________, my true and lawful attorney-in-fact and agent, with full power and

authority to do in my name and on my behalf any and all acts which I might do if personally present and

acting on my own behalf including, but without limiting the generality of forgoing the powers hereinafter set

forth. If ______________________________________________ shall die or resign as my attorney-in-fact,

I hereby appoint _______________________________________, as my attorney-in-fact, with all the rights

and powers of my original attorney-in-fact, including the following powers:

To demand, receive and receipt for all monies and property, tangible or intangible, of whatever kind,

to which I may be or may hereafter become entitled, the receipt of said attorney-in-fact being binding

upon me to the same extent as if made by me personally;

To purchase, lease, sub-lease, mortgage, pledge, sell, or otherwise deal with, any property, real or

personal, tangible or intangible, or mixed, which I may now own or hereafter acquire or in which I

may have or acquire any right title or interest of any kind;

To borrow or lend monies, and to give or receive security therefore;

To enter into contracts of any kind or description whatsoever, and to exercise any right, option or

election which I may have or acquire under any contract;

To compromise, settle or renew any claim of or against me, or any right which I may be entitled to

assert and which may be asserted against me;

To assert by litigation or otherwise any claim of mine, and to defend any claim that may be asserted

against me, with full right to employ counsel and agents which, in the discretion of said attorney-in-

fact, may be necessary in connection therewith;

To prepare and file tax returns of all kinds, including, but without limitation, Federal and State income

taxes, ad valorem taxes, license taxes and special assessments, and to pay such taxes or to

negotiate or agree with relation to postponements or deficiencies therein, or waivers of any statute of

limitation, including the right to protest or pay under protest any tax or assessment, and to employ

counsel or accountants for any matter in which the same may, in the discretion of my said attorney-

in-fact be helpful;

To cancel, surrender, borrow upon or change the beneficiary upon any policy of insurance, owned by

me or in which I may have an interest, and to exercise any further right in relation thereto which I

might exercise personally;

To sign checks upon, and withdraw funds from, any bank account/accounts which I may have or may

hereafter establish and to negotiate notes in my name and to endorse any check, note or other

negotiable instrument whatever payable to me;

10.

To execute instruments to affect the transfer of title to any motor vehicle owned by me;

DPofA_KY

Created 08/01; Revised 3/10 EG

Kentucky Health Care Power Of Attorney Form

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