Oklahoma General and Statutory Power of Attorney

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                             This General and Statutory Power of Attorney is intended to be used by an individual to
                             grant an agent powers with respect to his or her property and financial matters. It will
                             enable the agent to make decisions and act on behalf of the principal with broad powers or
                             the principal may list the specific powers granted to the agent. This power of attorney
                             becomes effective upon execution until the principal's death, disability or incapacity. This
                             document is useful for individuals located in Oklahoma who wish to appoint an agent to act
                             on their behalf.
             ®




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                 GENERAL AND STATUTORY POWER OF ATTORNEY

KNOW ALL PERSONS BY THESE PRESENTS:

I, ________________________________ [Instruction: Insert the name of principal]
hereinafter termed as the “Principal”, residing at ___________________ [Instruction: Insert
the Address of Principal], County of ______________ [Instruction: Insert the County], State
of Oklahoma, do hereby make, constitute and appoint ________________________________
[Instruction: Insert the name of attorney in fact/agent], hereinafter termed as “Agent”,
residing at ___________________ [Instruction: Insert the Address of attorney in fact], my
true and lawful attorney in fact for me and in my name and behalf.

My Agent shall have full power and authority to perform any act, power, duty, legal right, or
obligation whatsoever that I now have or may later acquire in connection with or relating to any
person, item, transaction, thing, business, property, real or personal, tangible, or intangible, or
matter whatsoever as I could do if personally present. I hereby ratify and confirm all acts that my
Agent, or my Agent’s substitute or substitutes, shall lawfully do or cause to be done by virtue of
this power of attorney and the rights hereby granted. My Agent’s powers and authority shall
include, but not be limited to:

(__)Real Estate property transactions;

(__)Tangible personal property transactions;

(__)Stock and bond transactions;

(__)Commodity and option 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 governmental programs or civil
or military service;

(__)Retirement plan transactions;

(__)Tax matters, including any transactions with the Internal Revenue Service;

(__)Decisions regarding lifesaving and life prolonging medical treatment;



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(__)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.

[Instruction: Mark an ‘X’ next to desired powers and draw a line through those you do not
wish to include]

IF NO POWER LISTED ABOVE IS CROSSED OUT, THIS DOCUMENT MAY BE
CONSTRUED AND INTERPRETED AS A GENERAL POWER OF ATTORNEY AND MY
AGENT (Attorney-in-Fact) MAY HAVE THE POWER AND AUTHORITY TO PERFORM
OR UNDERTAKE ANY ACTION I COULD PERFORM OR UNDERTAKE IF I WERE
PERSONALLY PRESENT.

SPECIAL INSTRUCTIONS: (Optional)

I grant my Agent the power to apply my property to make gifts, except that the amount of a gift
to an individual may not exceed the amount of annual exclusions allowed from the federal gift
tax for the calendar year of the gift.

[Comment: In the following space, the Principal may give special instructions limiting or
extending the powers granted to Agent].

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

This power of attorney becomes effective immediately and shall remain effective until my death
or until my disability or incapacity.

As used herein, “disability” or “incapacity” shall mean a lack of capacity to receive and evaluate
information effectively, to communicate decisions, and/or to manage my financial resources and
affairs properly.

This Power of Attorney shall be construed broadly as a General Power of Attorney. The listing
of specific terms, rights, acts, or powers are not intended to restrict or limit the definition or
scope of powers granted herein in any manner. If any part of this document is held to be invalid,
illegal, or unenforceable under applicable law, then the remaining unaffected parts of the
document shall still remain in full force and effect and not be affected by any partial invalidity.

Any third party who receives the copy of this document may act under it. Revocation or
termination of the power of attorney is not effective as to a third party until the third party has
actual notice or knowledge of such revocation or termination, and I, for myself and for my heirs,
executors, legal representatives, and assigns, hereby agree to indemnify and hold harmless any
such third party from and against any and all claims that may arise against such third party by
reason of such third party having relied on the provisions of this instrument.



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Successor Agent: If the Agent named by me shall die, become incompetent, resign, or refuse to
accept the office of Agent, I name the following (each to act alone and successively, in the order
named) as successor(s) to such Agent:

______________________________________________________________________________
______________________________________________________________________________

[Instructions: Insert the name(s) and address(es) of such successor(s) in the following
paragraph.) [Comment: Choose this clause if you or the Principal wish to name the
successor(s) of the Agent].

Neither the Agent nor his/her successor(s) shall be liable for losses resulting from judgment
errors made in good faith. However, Agent will be liable for breach of fiduciary duty, failure to
act in good faith, and/or willful misconduct, while acting under the authority of this Power of
Attorney.

I may revoke this Power of Attorney at any time by providing written notice to my Agent.

Signed this ______ [Month] ____ [Date], 20___ [Year].

_______________________________________
[Instruction: Insert the signature of Principal]

___________________________________________
[Instruction: Insert the printed name of Principal]

_______________________________________
[Instruction: Insert the signature of Agent]

___________________________________________
[Instruction: Insert the printed name of Agent]




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                                     ACKNOWLEDGMENT

STATE OF Oklahoma

COUNTY OF ______________________ [Instruction: Insert County

On the day of _____________________ [Instruction: Insert date], before me, the undersigned,
a Notary Public in and for said State, personally appeared personally known to me or proved to
me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed
to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the
individual(s), or the person upon behalf of which the individual(s) acted, executed the
instrument, and that such individual made such appearance before the undersigned in

_____________________________________________

[Instruction: Insert city/political subdivision and county

or state or other place where acknowledgment taken]

________________________________________________

(Signature and office of individual taking acknowledgment)

My commission expires: _________________________



THE ATTORNEY IN FACT OR AGENT, BY ACCEPTING OR ACTING UNDER THE
APPOINTMENT,    ASSUMES    THE  FIDUCIARY  AND   OTHER   LEGAL
RESPONSIBILITIES OF AN AGENT.




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Description: This General and Statutory Power of Attorney is intended to be used by an individual to grant an agent powers with respect to his or her property and financial matters. It will enable the agent to make decisions and act on behalf of the principal with broad powers or the principal may list the specific powers granted to the agent. This power of attorney becomes effective upon execution until the principal's death, disability or incapacity. This document is useful for individuals located in Oklahoma who wish to appoint an agent to act on their behalf.
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