Free Statutory Short Form of Power of Attorney - Montana

POWER OF ATTORNEY

(STATUTORY FORM)

NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING.
THEY ARE EXPLAINED IN THIS PART. IF YOU HAVE ANY QUESTIONS ABOUT THESE
POWERS, OBTAIN COMPETENT LEGAL ADVICE. THIS DOCUMENT DOES NOT AUTHORIZE
ANYONE TO MAKE MEDICAL AND OTHER HEALTH CARE DECISIONS FOR YOU, AND YOU
MAY REVOKE THIS POWER OF ATTORNEY IF YOU LATER WISH TO DO SO.

I, ________________________________________________________________

(insert your name and address)

appoint ___________________________________________________________

(insert the name and address of the person appointed)

as my agent (attorney-in-fact) to act for me in any lawful way with
respect to the following initialed subjects:

TO GRANT ALL OF THE FOLLOWING POWERS, INITIAL THE LINE IN FRONT OF (N)
AND IGNORE THE LINES IN FRONT OF THE OTHER POWERS. TO GRANT ONE OR MORE,
BUT FEWER THAN ALL, OF THE FOLLOWING POWERS, INITIAL THE LINE IN FRONT
OF EACH POWER YOU ARE GRANTING. TO WITHHOLD A POWER, DO NOT INITIAL THE
LINE IN FRONT OF IT. YOU MAY, BUT NEED NOT, CROSS OUT EACH POWER
WITHHELD.

INITIAL

__________ (A) Real property transactions;

__________ (B) Tangible personal property transactions;

__________ (C) Stock and bond transactions;

__________ (D) Commodity and option transactions;

__________ (E) Banking and other financial institution transactions;

__________ (F) Business operating transactions;

__________ (G) Insurance and annuity transactions;

__________ (H) Estate, trust, and other beneficiary transactions;

__________ (I) Claims and litigation;

__________ (J) Personal and family maintenance;

__________ (K) Benefits from Social Security, Medicare, Medicaid, or
other governmental programs or from military service;

__________ (L) Retirement plan transactions;

__________ (M) Tax matters;

__________ (N) ALL OF THE POWERS LISTED ABOVE. YOU NEED NOT INITIAL ALL
OTHER LINES IF YOU INITIAL LINE (N).

SPECIAL INSTRUCTIONS: ON THE FOLLOWING LINES, YOU MAY GIVE SPECIAL
INSTRUCTIONS LIMITING OR EXTENDING THE POWERS GRANTED TO YOUR AGENT.

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

UNLESS YOU DIRECT OTHERWISE ABOVE, THIS POWER OF ATTORNEY IS EFFECTIVE
IMMEDIATELY AND WILL CONTINUE UNTIL IT IS REVOKED.

This power of attorney revokes all previous powers of attorney signed by
me.

STRIKE THE PRECEDING SENTENCE IF YOU DO NOT WANT THIS POWER OF ATTORNEY
TO REVOKE ALL PREVIOUS POWERS OF ATTORNEY SIGNED BY YOU.

IF YOU DO WANT THIS POWER OF ATTORNEY TO REVOKE ALL PREVIOUS POWERS OF
ATTORNEY SIGNED BY YOU, YOU SHOULD READ THOSE POWERS OF ATTORNEY AND
SATISFY THEIR PROVISIONS CONCERNING REVOCATION. THIRD PARTIES WHO
RECEIVED COPIES OF THOSE POWERS OF ATTORNEY SHOULD BE NOTIFIED.

This power of attorney will continue to be effective if I become
disabled, incapacitated, or incompetent.

STRIKE THE PRECEDING SENTENCE IF YOU DO NOT WANT THIS POWER OF ATTORNEY
TO CONTINUE IF YOU BECOME DISABLED, INCAPACITATED, OR INCOMPETENT.

If it becomes necessary to appoint a conservator of my estate or
guardian of my person, I nominate my agent.

STRIKE THE PRECEDING SENTENCE IF YOU DO NOT WANT TO NOMINATE YOUR AGENT
AS CONSERVATOR OR GUARDIAN.

If any agent named by me dies, becomes incompetent, resigns or refuses
to accept the office of agent, I name the following (each to act alone
and successively, in the order named) as successor(s) to the agent:

1. ______________________________________________________________

2. ______________________________________________________________

3. ______________________________________________________________

For purposes of this subsection, a person is considered to be
incompetent if and while: (1) the person is a minor; (2) the person is
an adjudicated incompetent or a disabled person; (3) a conservator has
been appointed to act for the person; (4) a guardian has been appointed
to act for the person; or (5) the person is unable to give prompt and
intelligent consideration to business matters as certified by a licensed
physician.

I agree that any third person who receives a copy of this document may
act under it. I may revoke this power of attorney by a written document
that expressly indicates my intent to revoke. Revocation of the Power of
Attorney is not effective as to a third party until the third party
learns of the revocation. I agree to indemnify the third party for any
claims that arise against the third party because of reliance on this
Power of Attorney.

Signed this _______ day of ______________________________,
_____________.


____________________________________________

(Your
Signature)

Your Social Security Number: ________ - ______ - ________

State of Montana

County of ___________________________________________

This document was acknowledged before me on ___________________________.

Name of Principal: ___________________________________________________.

_____________________________________________________

Notary Public for the State of Montana

Residing at: __________________________________________

(Notarial Seal) My commission expires: ________________________________

BY SIGNING, ACCEPTING OR ACTING UNDER THIS APPOINTMENT, THE AGENT
ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES OF AN AGENT. THE
AGENT WORKS EXCLUSIVELY FOR THE BENEFIT OF THE PRINCIPAL. THE FOREMOST
DUTY AS THE AGENT IS THAT OF LOYALTY TO AND PROTECTION OF THE BEST
INTERESTS OF THE PRINCIPAL. THE AGENT SHALL DIRECT ANY BENEFITS DERIVED
FROM THE POWER OF ATTORNEY TO THE PRINCIPAL. THE AGENT HAS A DUTY TO
AVOID CONFLICTS OF INTEREST AND TO USE ORDINARY SKILL AND PRUDENCE IN
THE EXERCISE OF THESE DUTIES.

_________________________________________________

Signature of Agent

Signed this _________ day of _________________, 20_____.



DISCLAIMER

This Legal guide was complied by the DPHHS Aging Services Division Legal
Services Developer. This publication is not intended to be a substitute
for legal advice. Rather, it is designed to help families become better
acquainted with some of the devices used in long term planning and to
create an awareness of the need for such planning. Future changes in
laws cannot be predicted and statements in this narrative are based
solely on those laws in force on the date of publication.

We recommend that you seek legal advice for all your planning needs.