DURABLE POWER OF ATTORNEY

This power of attorney does not confer the power to make gifts unless additional provisions are added

KNOW ALL PERSONS BY THESE PRESENTS, Which are intended to constitute a DURABLE POWER OF ATTORNEY pursuant to Connecticut Statutory Short Form Power of Attorney Act:  

        That I, ________________________ (YOUR NAME), of ___________________________ (YOUR ADDRESS), Connecticut, hereby appoint_________________________________________ (name), of ______________________ (address) and ____________________________________ (name), of ______________________ (address), my attorney(s)-in-fact with full power of substitution to act (CROSS OUT ONE:) SEVERALLY or JOINTLY for me or in my name and behalf, as follows:  

        (a)    To hold and manage all real and personal property of every kind in which I may, from time to time, have an interest;  

        (b)    To invest, reinvest and manage my property, to receive any money owing or belonging to me and to receipt for it, to endorse any checks, notes or drafts payable to my order, to deposit in my name any money of mine in any checking or savings account or to use any such money for my account, to draw checks, notes or orders and to withdraw sums of money in my name from or against all funds on deposit to my credit, or in my name and that of another, with any bank or banks;  

        (c)    To buy, sell, assign, cash and liquidate any stocks, bonds or other securities owned by me or standing in my name, to exercise or sell and assign any stock rights or warrants of mine, to execute any proxy in my name, to deposit any stocks or other securities for the reorganization or change in the capital stock of any company in which I have an interest;  

        (d)    To have access to any safe deposit box in my name at any bank or other place;  

        (e)    To sell, lease or mortgage any real or personal property owned or leased by me and to enter into any contracts and execute all papers incidental thereto as deemed advisable and to exercise all my rights, privileges and powers with respect to zoning, condemnation and redevelopment;  

        (f)    To prepare, execute and file in my name any necessary tax returns, including federal and state income or other tax returns and estimates, requests and agreements for audits and any claims for refund of income or other taxes;  

        (g)    To employ servants, housekeepers, nurses, nurses' aides, attorneys, brokers, accountants and other specialists and pay reasonable compensation and charges for such employment;  

        (h)    To pay out of any money of mine all living, household and other expenses for my support and care and to pay all bills owed by me, including income and other taxes, and any sums that I may request to such persons as I may direct; and  

        (i)    To receipt for any registered letters, insured mail, certified mail and express packages intended for me.  

        THIS POWER OF ATTORNEY SHALL NOT BE AFFECTED BY THE SUBSEQUENT DISABILITY OR INCOMPETENCE OF THE PRINCIPAL.       

        I hereby ratify and confirm all that my said attorney(s) shall lawfully do by virtue hereof.  

        IN WITNESS WHEREOF, I have hereunto set my hand and seal at __________________, Connecticut, this _______ day of ______________, 20__.  
 

First Witness: ____________________  

Second Witness: ___________________

(Signature)______________________________  

Printed Name:__________________________________

            Personally appeared _______________, signer and sealer of the within and foregoing instrument and acknowledged the same to be his/her free act and deed, before me.  
  
                                                 ________________________________ 

ARRANGE FOR: 

• TWO ADULT WITNESSES; AND

• A NOTARY PUBLIC, CONNECTICUT ATTORNEY,  OR: (1) judge of court of record or a family support magistrate; (2) clerk or deputy clerk of a court having a seal;
  (3) commissioner of deeds or town clerk; or (4) justice of the peace

TO BE PRESENT DURING THE SIGNING 

• Your attorney(s)-in-fact may not be one of the witnesses.
• The notary or other person taking your “acknowledgment” may be one of the witnesses.
• Toward the top, print your name on the line beginning "That I."
• Print your town and state of residence after the word "of."
• You may name one or more persons to act as your attorney-in-fact, by inserting their names and addresses after the words "do hereby appoint," on the lines provided.
• You should "cross out" unused lines.
• If you have named more than one attorney-in-fact, CHECK the box for them to act "severally" or "jointly."
• There are several subdivisions, labeled (a) through (i), which represent the powers which you as principal may confer upon your attorney-in-fact.  If you do not wish to confer a particular power upon your attorney-in-fact, draw a line through the text of that subdivision and write your initials in the corresponding brackets.

• Insert the date on the line beginning "IN WITNESS WHEREOF."
• On the line labeled "L.S.," sign your name and print your name under the line.
• Each of TWO witnesses must sign on one of the two lines labeled "Witness," and should print his or her name under the signature.
• The notary, Connecticut attorney, etc. should ask you if the document is your "free act and deed," fill in the town and date of signing, fill in your name, sign on the line provided, and write in when his or her commission expires (if a notary).  If a notary or clerk with a seal, the seal should be embossed onto the document.  If a Connecticut attorney, no seal is required.