Special Durable Power of Attorney for Bank Account Matters

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									This is an agreement whereby a principal allows an agent to act on their behalf for bank
account matters. Typically, these agreements allow the agent to act on behalf of the
principal for any matter. This particular agreement only allows the agent to act on
behalf of the principal for bank account matters, and the agent may not act on behalf of
the principal for any other matter. Additionally, this agreement provides a durability
provision which allows the agent to act on behalf of the principal even if the principal
becomes mentally incapacitated. This agreement can be used by individuals that want
to allow another party to act on their behalf for bank account matters only.

                                FOR BANK ACCOUNT MATTERS


That I, ____________________________ [Instruction: Insert the name of principal] residing
at _______________________________ [Instruction: Insert the address of principal]
(hereinafter referred to as the “Principal”), being of sound mind and memory, do hereby make,
constitute and appoint ____________________________ [Instruction: Insert the name of
agent] residing at _________________________________ [Instruction: Insert the address of
agent], as my true and lawful Agent (hereinafter referred to as the “Agent”), with full power and
authority to act for me, individually, and in my name, place and stead, with reference to the
transaction of any and all business related to or connected with my bank accounts at
____________________________ Bank [Instruction: Insert the name of bank] having its
principal place of business at ____________________________ [Instruction: Insert the
branch address of the bank], of County ____________________________ [Instruction:
Insert the county], of State _________________, (hereinafter referred to as the “Bank”),
including, but not limited to, the following:

1. Making deposits, transfers and withdrawals to or from any of my bank accounts at Bank.
2. Writing, making and endorsing checks, drafts and other instruments in connection with my
    bank accounts at Bank.
3. Opening new checking, savings, money market, certificates of deposit, IRA’s (Individual
    Retirement Arrangement) or other accounts in my name and maintaining same.
4. Approving and authorizing automatic withdrawals from my accounts.
5. Executing signature cards for accounts maintained or opened by my Agent in my name.
6. To pay bills and other obligations of me, and to pay those bills on a current basis.
7. To manage my security holdings, and to employ or discharge professional financial advisors
    and managers if the Agent believes to be important.
8. Borrow from time to time such sums of money as the Agent may deem fit and proper in order
    to meet obligations rather than liquidate assets at depressed prices and execute promissory
    notes, security deeds or agreements, financial statements, or other security instruments in

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    such form as the lender may request and renew said notes and security instruments from time
    to time in whole or in part. [Instruction: Please remove this clause if you do not wish to
    grant power to Agent to borrow money.]
9. To have free access at any time or times to any safe deposit box or vault to which I might
    have access.
10. Performing any and all other matters relating to, or in connection with, my bank accounts at
I direct that the above-related powers and authority of my said Agent shall be so exercisable and
effective regardless of the fact that I may be mentally or physically incapacitated or incapable of
understanding or unable to express myself or act in my own behalf at the time of any action on
my behalf by the said Agent. Such incapacity, whether mental or physical, that I may exhibit
shall not in any way interfere with the authority of my Agent herein to act fully on my behalf
according to the terms hereof. In other words, this Power of Attorney shall not be affected by
my subsequent disability, incompetence or incapacity.
And I do hereby undertake to ratify and confirm, all and singular, the acts heretofore performed
and to be hereinafter performed by my said Agent, acting in my name and on my behalf.

Bank shall honor this Power of Attorney until and unless Bank receives written notice of
revocation of same signed by me. Bank is hereby indemnified and shall be held harmless by me
for any and all actions taken by my Agent regarding my accounts at Bank, regardless of whether
within the intended scope of this Power of Attorney or not; therefore, Bank shall have no liability
for the actions of my Agent or for following the directions of my Agent in connection with my
bank accounts at Bank.

IN WITNESS WHEREOF, I have executed this Power of Attorney on this _____ [Month]
______ [Date] 20___

[Instruction: Insert signature of Principal]

 [Instruction: Insert typed/printed name of Principal]

Signed sealed and delivered in the presence of:

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[Instruction: Insert signature of Witness #1]


[Instruction: Insert name and address of Witness #1]

[Instruction: Insert signature of Witness #2]


[Instruction: Insert name and address of Witness #2]

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State of _________________

County of __________________

I, the undersigned, a Notary Public in and for said County in said State, hereby certify that
______________________________, who is known to me, acknowledged before me on this day
that, being informed of the contents of the instrument, he/she executed the same voluntarily on
the day the same bears date

Given under my hand and official seal this the ________ day of ________, ____.


                                                     Notary Public

My Commission Expires: ______________


© Copyright 2012 Docstoc Inc.                                                       5

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