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

Universal Citation: GA Code § 10-6B-70 (2017)
  • 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

  • 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

  • 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

  • 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

    • 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
      • 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,

      • 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. "
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