2017 Georgia Code
Title 10 - Commerce and Trade
Chapter 6B - Uniform Power of Attorney
Article 3 - Statutory Forms
§ 10-6B-70. Form power of attorney
- A document substantially in the following form may be used to create a statutory form power of attorney that has the meaning and effect prescribed by this chapter.
"State of Georgia
County of ____
STATUTORY FORM POWER OF ATTORNEY
IMPORTANT INFORMATION
This power of attorney authorizes another person (your agent) to make
decisions concerning your property for you (the principal). Your agent will be
able to make decisions and act with respect to your property (including your
money) whether or not you are able to act for yourself. The meaning of
authority over subjects listed on this form is explained in O.C.G.A. Chapter
6B of Title 10.
This power of attorney does not authorize the agent to make health care
decisions for you.
You should select someone you trust to serve as your agent. Unless you
specify otherwise, generally the agent's authority will continue until you die
or revoke the power of attorney or the agent resigns or is unable to act for
you. If you revoke the power of attorney, you must communicate your revocation
by notice to the agent in writing by certified mail and file such notice with
the clerk of superior court in your county of domicile.
Your agent is not entitled to any compensation unless you state otherwise
in the Special Instructions. Your agent shall be entitled to reimbursement of
reasonable expenses incurred in performing the acts required by you in your
power of attorney.
This form provides for designation of one agent. If you wish to name more
than one agent, you may name a successor agent or name a coagent in the
Special Instructions. Coagents will not be required to act together unless you
include that requirement in the Special Instructions.
If your agent is unable or unwilling to act for you, your power of attorney
will end unless you have named a successor agent. You may also name a second
successor agent.
This power of attorney shall be durable unless you state otherwise in the
Special Instructions.
This power of attorney becomes effective immediately unless you state
otherwise in the Special Instructions.
If you have questions about the power of attorney or the authority you are
granting to your agent, you should seek legal advice before signing this form.DESIGNATION OF AGENT
I ____ (Name of principal) name the following person as my agent:
- Name of agent:____
Agent's address:____
Agent's telephone number:____
Agent's e-mail address:____
DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)
If my agent is unable or unwilling to act for me, I name as my successor
- Name of agent:____
- agent:
- Name of successor agent:____
Successor agent's address:____
Successor agent's telephone number:____
Successor agent's e-mail address:____
If my successor agent is unable or unwilling to act for me, I name as my
- Name of successor agent:____
- second successor agent:
- Name of second successor agent:____
Second successor agent's address:____
Second successor agent's telephone number:____
Second successor agent's e-mail address:____
GRANT OF GENERAL AUTHORITY
I grant my agent and any successor agent general authority to act for me
with respect to the following subjects as defined in O.C.G.A. Chapter 6B of
- Name of second successor agent:____
- Title 10:
- (INITIAL each subject you want to include in the agent's general authority.
If you wish to grant general authority over all of the subjects you may
initial "all preceding subjects" instead of initialing each subject.)
( ) Real property
( ) Tangible personal property
( ) Stocks and bonds
( ) Commodities and options
( ) Banks and other financial institutions
( ) Operation of entity or business
( ) Insurance and annuities
( ) Estates, trusts, and other beneficial interests
( ) Claims and litigation
( ) Personal and family maintenance
( ) Benefits from governmental programs or civil or military service
( ) Retirement plans
( ) Taxes
( ) All preceding subjects
GRANT OF SPECIFIC AUTHORITY (OPTIONAL)
My agent SHALL NOT do any of the following specific acts for me UNLESS I
have INITIALED the specific authority listed below:
- (CAUTION: Granting any of the following will give your agent the authority
to take actions that could significantly reduce your property or change how
your property is distributed at your death. INITIAL ONLY the specific
authority you WANT to give your agent. You should give your agent specific
instructions in the Special Instructions when you authorize your agent to make
gifts.)
( ) Create, amend, revoke, or terminate an inter vivos trust
( ) Make a gift, subject to the limitations of O.C.G.A. ยง 10-6B-56 and
any Special Instructions in this power of attorney
( ) Create or change rights of survivorship
( ) Create or change a beneficiary designation
( ) Authorize another person to exercise the authority granted under this
power of attorney
( ) Waive the principal's right to be a beneficiary of a joint and
survivor annuity, including a survivor benefit under a retirement plan
( ) Access the content of electronic communications
( ) Exercise fiduciary powers that the principal has authority to delegate
( ) Disclaim or refuse an interest in property, including a power of
appointment
LIMITATION ON AGENT'S AUTHORITY
An agent that is not my ancestor, spouse, or descendant SHALL NOT use my
property to benefit the agent or a person to whom the agent owes an obligation
of support unless I have included that authority in the Special Instructions.
SPECIAL INSTRUCTIONS (OPTIONAL)
You may give special instructions on the following lines (you may add lines
or place your special instructions in a separate document and attach it to the
- (CAUTION: Granting any of the following will give your agent the authority
- power of attorney):
- ____
____
____
____
____
____
EFFECTIVE DATE
This power of attorney is effective immediately unless I have stated
otherwise in the Special Instructions.
NOMINATION OF CONSERVATOR (OPTIONAL)
If it becomes necessary for a court to appoint a conservator of my estate,
- ____
- I nominate the following person(s) for appointment:
- Name of nominee for conservator of my estate:
- ____
Nominee's address:____
Nominee's telephone number:____
Nominee's e-mail address:____
RELIANCE ON THIS POWER OF ATTORNEY
Any person, including my agent, may rely upon the validity of this power of
attorney or a copy of it unless that person has actual knowledge it has
terminated or is invalid.
SIGNATURE AND ACKNOWLEDGMENT
____ ____
Your signature Date
____
Your name printed
____
____
Your address
____
Your telephone number
____
Your e-mail address
This document was signed in my presence on____,
(Date)
by ____.
(Name of principal)
____.
(Witness's name printed)
____
____
Witness's address
____
Witness's telephone number
____
Witness's e-mail address
State of Georgia
County of ____
This document was signed in my presence on____,
(Date)
by ____.
(Name of principal)
____ (Seal)
Signature of notary
My commission expires: ____
This document prepared by:____ .
IMPORTANT INFORMATION FOR AGENT
Agent's Duties
When you accept the authority granted under this power of attorney, a
special legal relationship is created between you and the principal. This
relationship imposes upon you legal duties that continue until you resign or
- ____
- the power of attorney is terminated or revoked. You must:
- (1) Do what you know the principal reasonably expects you to do with the
principal's property or, if you do not know the principal's expectations, act
in the principal's best interest;
- (2) Act in good faith;
- (3) Do nothing beyond the authority granted in this power of attorney;
and
- (4) Disclose your identity as an agent whenever you act for the
- (1) Do what you know the principal reasonably expects you to do with the
- principal by writing or printing the name of the principal and signing your
own name as "agent" in the following manner:
- ____ by ____ as Agent.
(Principal's name) (Your signature)
Unless the Special Instructions in this power of attorney state otherwise,
- ____ by ____ as Agent.
- you must also:
- (1) Act loyally for the principal's benefit;
- (2) Avoid conflicts that would impair your ability to act in the
principal's best interest;
- (3) Act with care, competence, and diligence;
- (4) Keep a record of all receipts, disbursements, and transactions made
on behalf of the principal;
- (5) Cooperate with any person that has authority to make health care
decisions for the principal to do what you know the principal reasonably
expects or, if you do not know the principal's expectations, to act in the
principal's best interest; and
- (6) Attempt to preserve the principal's estate plan if you know the plan
- and preserving the plan is consistent with the principal's best interest.
Termination of Agent's Authority
You must stop acting on behalf of the principal if you learn of any event
that terminates this power of attorney or your authority under this power of
attorney. Events that terminate a power of attorney or your authority to act
under a power of attorney include:
- (1) Death of the principal;
- (2) The principal's revocation of your authority or the power of
attorney so as long as the revocation of the power of attorney is communicated
to you in writing by certified mail and provided that such notice is filed
with the clerk of superior court in the county of domicile of the principal;
- (3) The occurrence of a termination event stated in the power of
attorney;
- (4) The purpose of the power of attorney is fully accomplished; or
- (5) If you are married to the principal, a legal action is filed with a
- court to end your marriage, or for your legal separation, unless the Special
Instructions in this power of attorney state that such an action will not
terminate your authority.
Liability of Agent
The meaning of the authority granted to you is defined in O.C.G.A. Chapter
6B of Title 10. If you violate O.C.G.A. Chapter 6B of Title 10 or act outside
the authority granted, you may be liable for any damages caused by your
violation.
If there is anything about this document or your duties that you do not
understand, you should seek legal advice. "
- Name of nominee for conservator of my estate:
- (INITIAL each subject you want to include in the agent's general authority.