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APPENDIX A3

Durable General Power of Attorney


New York Statutory Gifts Rider
ransactions
Authorization for Certain Gift Transactions

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ONAL RIDER ALL


CAUTION TO THE PRINCIPAL: THIS OPTIONAL
ALLOWS
YOU TO AUTHORIZE YOUR AGENT
O AN
GENT TO MAKE GIFTS IN EXCESS OF
ANNUAL TOTAL OF $500
O TH
500 FOR ALL GIFTS DESCRIBED IN (I) OF
THE
CTION OF TH
GRANT OF AUTHORITY
HORITY SECTION
THE STATUTORY
ATUTORY SHORT FOR
ORM
RNEY
POWER OF ATTORNEY
(UNDER PERSON
PERSONAL
AND
FAMILY
T
NTENANCE), OR CERTAIN OTHER GIFT TRANSACT
TRANSACTIONS DURING
MAINTENANCE
ETIME. YOU DO NOT HAVE TO EXECUTE
EXE
YOUR LIFETIME
THIS RIDER IF YOU
ONLY WANT YOUR AGENT TO MAKE GIFTS DESCRIBED IN (I) OF THE
F AUTHORITY SECTION
S
GRANT OF
OF THE STATUTORY SHORT FORM
TTORNE AND YO
POWER OF ATTORNEY
YOU INITIALED , ON THAT SECTION
HAT FORM. GRANTIN
OF THAT
RANTING ANY OF THE FOLLOWING AUTHORITY TO
A
YOUR AGENT
GIVES YOUR AGENT THE AUTHORITY TO TAKE ACTIONS
THA COULD SIGNIFICANTLY REDUCE YOUR PROPERTY OR CHANGE
THAT
HOW Y
YOUR PROPERTY IS DISTRIBUTED AT YOUR DEATH. &ERTAIN
G
GIFT TRANSACTIONS ARE DESCRIBED IN SECTION 5-1514 OF THE
GENERAL OBLIGATIONS LAW. THIS GIFTS RIDER DOES NOT REQUIRE
N HE OR
YOUR AGENT TO EXERCISE GRANTED AUTHORITY, BUT WHEN
SHE EXERCISES THIS AUTHORITY, HE OR SHE MUST ACT
CT ACCORDING
ACCORDIN
WISE IN YOUR BES
TO ANY INSTRUCTIONS YOU PROVIDE, OR OTHERWISE
RWISE
BEST
INTEREST.

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THIS GIFTS RIDER AND THE POWER


WER OF ATTORNEY IT SUPPLEMENTS
NSTRUMENT.
MUST BE READ TOGETHER AS A SINGLE INSTRUMENT

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OCUMENT AUTHORIZING YOUR


Y
BEFORE SIGNING
NG THIS DOCUMENT
AGENT TO
OULD SEEK LEGAL ADVICE
ADVIC TO ENSU
MAKE GIFTS
IFTS, YOU SHOULD
ENSURE THAT
E
UR INTENTIONS ARE CLEARLY AND PROPERLY EXPR
YOUR
EXPRESSED.

TO MAKE GIFTS
(a) GRANT OF LIMITED AUT
AUTHORITY T

ranting gifting author


Granting
authority to your agent gives your agent the authority to
take
significantly reduce your property. If you wish to
ke actions that
th could sign
ake
allow
make gifts to himself or herself, you must separately
ow your agent to m
grant
in subdivision (c) below.
nt that authority
autho
To grant your agent the gifting authority provided below, initial the
bracket to the left of the authority.

(______) I grant authority to my agent to make gifts to my spouse,


children and more remote descendants, and parents, not to
exceed, for each donee, the annual federal gift
ft tax exclusion
amount pursuant to the Internal Revenue Code. For gif
gifts to my
children and more remote descendants,
the
dants, and parents,
paren
endants,
parent
maximum amount of the gift
exceed
ft to eachh donee shall not ex
twice the gift tax exclusion
ount, if my spouse agrees
agre to
lusion amount,
agree
split-gift treatment
nt to the Internal Revenue Code.
C
ent pursuant
Cod
This authority
instr
ority must be exercised pursuant to my instructions,
instruction
or otherwise for purposes that the agent reaso
deems to
reasonably deem
be in myy best interest.
intere

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(b) MODIFICATIONS:

authorize gifts in amounts smaller than the


Use this section if you wish to authoriz
amounts in excess of the gift tax exclusion
am
gift tax exclusion amount,
in am
beneficiaries or other gift transactions. Granting
ount, gifts to other be
amount,
your agent gives your agent the authority to take actions
such aut
authority to yo
significantly reduce your property and/or change how your
th could si
that
property is distributed at your death. If you wish to authorize your agent
propert
to make gifts or transfers to himself or herself, you must separately grant
that authority in subdivision (c) below.

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(______) I grant the following authority to my agent to make gifts or


transfers pursuant to my instructions,
ns, or otherwise for
purposes that the agent reasonably
bly deems to be in my best
interest:

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(c) GRANT OF SPECIFIC


C AUTHORITY FOR AN AGENT
AGE
TO
MAKE GIFTS TO
(OPTIONAL)
O HIMSELF OR HERSELF: (OPTIONA

Iff you wish to authorize your agent to make gifts to hhimself or herself,
indicating
to which agent(s)
se
you must grant that authority in this section,
indi
and guidelines.
the authorization is granted, and any limitations
limita

specific authority
for the following agent(s) to make
_____) I grant sp
(______)
auth
the following gifts to himself or herself:

This authority must be exercised pursuant to my instructions, or


otherwise for purposes that the agent reasonably deems to be in my best
interest.

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(d) ACCEPTANCE BY THIRD PARTIES: I agree to indemn


indemnify the
third party for any claims that may arisee againstt the third party because
be
of reliance on this Statutory Gifts Rider.

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(e) SIGNATURE OF PRINCIPAL AND ACKNOWLEDGMENT:


ACKNOWLEDGMEN

In Witnesss Whereof I have hereunto signed my name on ________,


___
20__.
_

RINCIPAL signs here: => ___________________________________


__
PRINCIPAL
___________
YORK
STATE O
OF NEW YOR

) ss.:

COUNTY OF _________

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On the ________ day of __________, in the year 20___, before m


me,
the undersigned, a Notary Public in and for said state, ppersonal
personally
appeared _________________, personally known
n to me or proved to me
on the basis of satisfactory evidence to be the person
on whose name is
subscribed to the within instrument and acknowledged
wledged to me that he/she
executed the same in his/her capacity, andd that by his/her signature on
the instrument, the person
ntity upon behalf of which the
th person
on or the entity
acted executed the instrument..

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_______________________________
Pub
Notary Public

(f) SIGNATURES OF WITNESSES:

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By signing as a witness, I acknowledge that the principal


pal ssigned the
Statutory Gifts Rider in my presence and the presence
esence of the
th other
ZLWQHVV RU WKDW WKH SULQFLSDO DFNQRZOHGJHG WR
SULQFLSDOV
R PH WKDW WKH SULQ
signature was affixed by him or her or at his or her direction. I also
acknowledge that the principal has
is Statutory Gifts Rider
as stated that this
R
reflects his or her wishes andd that he or she has signed it voluntarily. I am
not named herein as a permissible recipient
gifts.
cipient of gifts

Signature of witness 1

S
Sign
Signature of witness 2

Da
Date

Date

Print name

Print name

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Address

City, State ZIP Code

Address

City, State,, ZIP Code

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ed by:
(g) This document
ent prepared

2010 N.Y. L
Laws ch. 340