SAMPLE POWER OF ATTORNEY FORM
_________________________ (the “Grantor”) hereby grants to _________________________________
(the “Agent”) a general power of attorney. As the Grantor’s attorney in fact, the Agent shall have
full power and authority to undertake any and all acts that may be lawfully undertaken on behalf
of the grantor including, but not limited to, the right to buy, sell, lease, mortgage, assign, rent, or
otherwise dispose of any real or personal property belonging to the Grantor; to execute, accept,
undertake, and perform contracts in the name of the Grantor; to deposit, endorse, or withdraw
funds to or from any bank depository of the Grantor; to initiate, defend, or settle legal actions on
behalf of the Grantor; and to retain any accountant, attorney, or other advisor deemed by the Agent
to be necessary to protect the interests of the Grantor in relation to such powers.
By accepting this grant, the Agent agrees to act in a fiduciary capacity consistent with the reasonable
best interests of the Grantor. This power of attorney may be revoked by the Grantor at any
time; however, any person dealing with the Agent as attorney in fact may rely on this appointment
until receipt of actual notice of termination.
IN WITNESS WHEREOF, the undersigned grantor has executed this power of attorney underseal as of the _________day of ______________, ___________.
STATE OF New York
COUNTY OF Jamaica
I certify that _______________________________, who ❏ is personally known to me to be the person
whose name is subscribed to the foregoing instrument ❏ produced ___________________________
as identification, personally appeared before me on _________________________, and ❏ acknowledged
the execution of the foregoing instrument ❏ acknowledged that (s)he is (Assistant)
Secretary of ___________________________________________________ and that by authority duly
given and as the act of the corporation, the foregoing instrument was signed in its name by its
(Vice) President, sealed with its corporate seal, and attested by him/her as its (Assistant) Secretary.
Notary Public, State of New York
I hereby accept the foregoing appointment as attorney in fact on ____________________________.