Pennsylvania General Durable Power of Attorney Form - Free Download | Page 6
The Pennsylvania general durable power of attorney is an important legal document for a general purpose that gives the attorney-in-fact enduring authority, which will exist even if the grantor becomes incapacitated to make his/her own decisions.
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Pennsylvania General Durable Power of Attorney Form Page 6
Pennsylvania General Durable Power of Attorney Form
COUNTY OF ________________
On this, the _____ day of _________________, 20____, before me
________________________________________, the undersigned officer, personally appeared
_____________________________________________________________________________,
known to me (or satisfactorily proven) to be the person(s) whose name(s) is/are subscribed to the
within instrument, and acknowledged that __________________________________ executed
the same for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seals.
[Notary Seal, if any]:
_______________________________
(Signature of Notarial Officer)
Notary Public for the Commonwealth of
Pennsylvania
My commission expires: ___________________
ACKNOWLEDGMENT EXECUTED BY AGENT
I, ________________________________________________ [name of agent], have read the attached
power of attorney and am the person identified as the agent for the principal. I hereby acknowledge that in
the absence of a specific provision to the contrary in the power of attorney or in 20 Pa.C.S. when I act as
agent:
I shall exercise the powers for the benefit of the principal.
I shall keep the assets of the principal separate from my assets.
I shall exercise reasonable caution and prudence.
I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal.
__________________________________
Agent's Signature
__________________________________
Agent's Printed Name
__________________________________
Date
PREPARATION STATEMENT
This document was prepared by the following individual:
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Pennsylvania General Durable Power of Attorney Form