STATUTORY FORM POWER OF ATTORNEY - Montana State University

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Montana Statutory Form Power of AttorneyImportant Information for PrincipalThis power of attorney authorizes another person (your agent) to make decisions concerning yourproperty for you (the principal). Your agent will be able to make decisions and act with respect to yourproperty (including your money) whether or not you are able to act for yourself. The meaning of authorityover subjects listed on this form is explained in the Montana Codes Annotated, Uniform Power of AttorneyAct, Title 72, chapter 31, part 3.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 theagent's authority will continue until you die or revoke the power of attorney or the agent resigns or isunable to act for you.Your agent is entitled to reasonable compensation unless you state otherwise in the Special Instructions.This form provides for designation of one agent. If you wish to name more than one agent, you may namea coagent in the Special Instructions. Coagents are not required to act together unless you include thatrequirement in the Special Instructions.If your agent is unable or unwilling to act for you, your power of attorney will end unless you have nameda successor agent. You may also name a second successor agent.This power of attorney becomes effective immediately unless you state otherwise in the SpecialInstructions.If you have questions about the power of attorney or the authority you are granting to your agent, youshould seek legal advice before signing this form.Montana Code Annotated 2017, Statutory Form Power of Attorney §72-31-353

Montana Statutory Form Power of Attorney 1 of 3DESIGNATION OF AGENTI(Name of Principal)name the following person as my agent:Name of Agent:Agent’s Address:Agent’s Telephone Number: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: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:GRANT OF GENERAL AUTHORITYI grant my agent and any successor agent general authority to act for me with respect to the followingsubjects as defined in the Uniform Power of Attorney Act, Title 72, chapter 31, part 3:INITIAL each subject you want to include in the agent's general authority. If you wish to grant generalauthority 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 SubjectsMontana Code Annotated 2017, Statutory Form Power of Attorney §72-31-353

Montana Statutory Form Power of Attorney 2 of 3LIMITATION ON AGENT’S AUTHORITYAn agent that is not my ancestor, spouse, or descendant MAY NOT use my property to benefit the agentor a person to whom the agent owes an obligation of support unless I have included that authority in theSpecial Instructions.SPECIAL INSTRUCTIONS (OPTIONAL)You may give special instructions on the following lines:EFFECTIVE DATEThis power of attorney is effective immediately unless I have stated otherwise in the Special Instructions.NOMINATION OF CONSERVATOR OR GUARDIAN (OPTIONAL)If it becomes necessary for a court to appoint a conservator or guardian of my estate or guardian of myperson, I nominate the following person(s) for appointment:Name of Nominee for conservator or guardian of my estate:Nominee’s Address:Nominee’s Telephone Number:Name of Nominee for guardian of my person:Nominee’s Address:Nominee’s Telephone Number:RELIANCE ON THIS POWER OF ATTORNEYAny person, including my agent, may rely upon the validity of this power of attorney or a copy of it unlessthat person knows it has terminated or is invalid.Montana Code Annotated 2017, Statutory Form Power of Attorney §72-31-353

Montana Statutory Form Power of Attorney 3 of 3SIGNATURE AND ACKNOWLEDGMENTYour SignatureDateYour Name PrintedYour AddressYour Telephone NumberState of MontanaCounty ofThis document was acknowledged before me onby .Print name of signer(s)Notary Signature[Montana notaries must complete the following, if notpart of stamp.]Printed NameAffix seal/stamp as closeto signature as possible.signature as possible.Notary Public for the State of MontanaResiding atMy Commission expires:,20Montana Code Annotated 2017, Statutory Form Power of Attorney §72-31-353

Montana Statutory Form Power of AttorneyIMPORTANT INFORMATION FOR AGENTAgent’s DutiesWhen you accept the authority granted under this power of attorney, a special legal relationship is createdbetween you and the principal. This relationship imposes upon you legal duties that continue until youresign 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 youdo 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 nameof the principal and signing your own name as "agent" in the following manner: (Principal's Name)by (Your Signature) as AgentUnless the Special Instructions in this power of attorney state otherwise, you must also:(1)(2)(3)(4)(5)act loyally for the principal's benefit;avoid conflicts that would impair your ability to act in the principal's best interest;act with care, competence, and diligence;keep a record of all receipts, disbursements, and transactions made on behalf of the principal;cooperate with any person that has authority to make health care decisions for the principal to dowhat 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 isconsistent with the principal's best interest.TERMINATION OF AGENT’S AUTHORITYYou must stop acting on behalf of the principal if you learn of any event that terminates this power ofattorney or your authority under this power of attorney. Events that terminate a power of attorney or yourauthority to act under a power of attorney include:(1)(2)(3)(4)(5)death of the principal;the principal's revocation of the power of attorney or your authority;the occurrence of a termination event stated in the power of attorney;the purpose of the power of attorney is fully accomplished; orif you are married to the principal, a legal action is filed with a court to end your marriage, or foryour legalseparation, unless the Special Instructions in this power of attorney state that suchan action will not terminate your authority.LIABILITY OF AGENTThe meaning of the authority granted to you is defined in the Uniform Power of Attorney Act, Title 72,chapter 31, part 3. If you violate the Uniform Power of Attorney Act, Title 72, chapter 31, part 3, or actoutside 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 legaladvice.Montana Code Annotated 2017, Statutory Form Power of Attorney §72-31-353

AGENT’S CERTIFICATIONMontana Code Annotated §72-31-353AS TO THE VALIDITY OF POWER OF ATTORNEY AND AGENT'S AUTHORITYState ofCounty of:(Name of Agent)Icertify under penalty of perjury that(Name of Principal) granted my authority as anagent or successor agent in a power of attorney datedI further certify that to my knowledge:(1) the principal is alive and has not revoked the power of attorney or my authority to act under the power of attorney and thepower of attorney and my authority to act under the power of attorney have not terminated;(2) if the power of attorney was drafted to become effective upon the happening of an event or contingency, the event orcontingency has occurred;(3) if I was named as a successor agent, the prior agent is no longer able or willing to serve; and(4)(Insert Other Relevant Statements)SIGNATURE AND ACKNOWLEDGEMENTAgent’s SignatureDateAgent’s Name PrintedAgent’s AddressAgent’s Telephone NumberState ofCounty ofSigned and sworn to (or affirmed) before me onby(Date)Name of Agent.Notary Signature[Montana notaries must complete the following, if not partof stamp.]Affix seal/stamp as close tosignature as possible.Printed NameNotary Public for the State of MontanaResiding atMy Commission expires:, 20Montana Code Annotated 2017, Statutory Form Power of Attorney §72-31-353

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. Montana Code Annotated 2017, Statutory Form Power of Attorney §72-31-353

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