Connecticut Durable Power of Attorney Form

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The Durable power of attorney form allows for anyone to choose an agent to represent and act in their place for financial decisions. The decisions can be any of the following and must be checked by the person granting power.

real estate transactions
chattel and goods transactions
bond, share and commodity transactions
banking transactions
business operating transactions
insurance transactions
estate transactions
claims and litigation
personal relationships and affairs
benefits from military service
records, reports and statements
all other matters

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“Notice: The powers granted by this document are broad and sweeping. They are defined in Connecticut Statutory Short Form Power of Attorney Act, sections 1-42 to 1-56, inclusive, of the general statutes, which expressly permits the use of any other or different form of power of attorney desired by the parties concerned. The grantor of any power of attorney or the attorney-in-fact may make application to a court of probate for an accounting as provided in subsection (b) of section 45a-175.

Know All Men by These Presents, which are intended to constitute a GENERAL POWER OF ATTORNEY pursuant to Connecticut Statutory Short Form Power of Attorney Act:

That I …. (insert name and address of the principal) do hereby appoint …. (insert name and address of the agent, or each agent, if more than one is designated) my attorney(s)-in-fact TO ACT …..

If more than one agent is designated and the principal wishes each agent alone to be able to exercise the power conferred, insert in this blank the word `severally’. Failure to make any insertion or the insertion of the word `jointly’ shall require the agents to act jointly.

First: In my name, place and stead in any way which I myself could do, if I were personally present, with respect to the following matters as each of them is defined in the Connecticut Statutory Short Form Power of Attorney Act to the extent that I am permitted by law to act through an agent:

(Strike out and initial in the opposite box any one or more of the subdivisions as to which the principal does NOT desire to give the agent authority. Such elimination of any one or more of subdivisions (A) to (K), inclusive, shall automatically constitute an elimination also of subdivision (L).)

To strike out any subdivision the principal must draw a line through the text of that subdivision AND write his initials in the box opposite.

(A)    real estate transactions; (      )
(B)    chattel and goods transactions; (      )
(C)    bond, share and commodity transactions; (      )
(D)    banking transactions; (      )
(E)    business operating transactions; (      )
(F)    insurance transactions; (      )
(G)    estate transactions; (      )
(H)    claims and litigation; (      )
(I)    personal relationships and affairs; (      )
(J)    benefits from military service; (      )
(K)    records, reports and statements; (      )
(L)    all other matters; (      )

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(Special provisions and limitations may be included in the statutory short form power of attorney only if they conform to the requirements of the Connecticut Statutory Short Form Power of Attorney Act.)

Second: With full and unqualified authority to delegate any or all of the foregoing powers to any person or persons whom my attorney(s)-in-fact shall select;

Third: Hereby ratifying and confirming all that said attorney(s) or substitute(s) do or cause to be done.

In Witness Whereof I have hereunto signed my name and affixed my seal this …. day of …., 20…

…. (Signature of Principal) (Seal)

(ACKNOWLEDGMENT)

The execution of this statutory short form power of attorney shall be duly acknowledged by the principal in the manner prescribed for the acknowledgment of a conveyance of real property.

No provision of this chapter shall be construed to bar the use of any other or different form of power of attorney desired by the parties concerned.

Every statutory short form power of attorney shall contain, in boldface type or a reasonable equivalent thereof, the “Notice” at the beginning of this section.

(b) A power of attorney is a “statutory short form power of attorney”, as this phrase is used in this chapter, when it is in writing, has been duly acknowledged by the principal and contains the exact wording of clause First set forth in subsection (a) of this section, except that any one or more of subdivisions (A) to (K) may be stricken out and initialed by the principal, in which case the subdivisions so stricken out and initialed and also subdivision (L) shall be deemed eliminated. A statutory short form power of attorney may contain modifications or additions of the types described in section 1-56.

(c) If more than one agent is designated by the principal, such agents, in the exercise of the powers conferred, shall act jointly unless the principal specifically provides in such statutory short form power of attorney that they are to act severally.

(d) (1) The principal may indicate that a power of attorney duly acknowledged in accordance with this section shall take effect upon the occurrence of a specified contingency, including a date certain or the occurrence of an event, provided that an agent designated by the principal executes a written affidavit in accordance with section 1-56h that such contingency has occurred.

(2) The principal may indicate the circumstance or date certain upon which the power of attorney shall cease to be effective.

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