Power Of Attorney Form - South Dakota (Page 2 of 4) in pdf

Power Of Attorney Form - South Dakota Page 2

As my attorney-in-fact.

My attorney-in-fact may act on my behalf for the following purpose(s):

[____] Real Estate Transactions

[____] Stock and Bond Transactions

[____] Commodity and Option Transactions

[____] Tangible Personal Property Transactions

[____] Banking and Other Financial Institution Transactions

[____] Business Operating Transactions

[____] Insurance and Annuity Transactions

[____] Estate, Trust and Other Beneficiary Transactions

[____] Claims and Litigation

[____] Personal and Family Maintenance

[____] Benefits from Social Security, Medicare, Medicaid or Other Government Programs

[____] Retirement Plan Transactions

[____] Tax Matters, including any transactions with the Internal Revenue Service

[____] Decisions Regarding Lifesaving and Life Prolonging Medical Treatment.

[____] Decisions Relating to Medical Treatment, Surgical Treatment, Nursing Care, Medication,

Hospitalization, Institutionalization in a nursing home or other facility and home health care.

[____] Transfer of Property or Income as a Gift to the Principal’s Spouse for the purpose of

qualifying the principal for governmental medical assistance.

[____] All OF THE ABOVE POWERS, INCLUDING FINANCIAL AND HEALTH CARE DECISIONS.

This power of attorney shall take effect on the following date:

____/____/______

and will continue indefinitely or until revoked by me or by my death.

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Power Of Attorney Form - South Dakota Page 2