Statutory Short Form Power Of Attorney {100.1.1}

(Top 3 inches reserved for recording data) STATUTORY SHORT FORM POWER OF ATTORNEY MINNESOTA STATUTES, SECTION 523.23 Minnesota Uniform Conveyancing Blanks Form 100.1.1 (2014) STATUTORY SHORT FORM POWER OF ATTORNEY MINNESOTA STATUTES, SECTION 523.23 Before completing and signing this form, the principal must read and initial the IMPORTANT NOTICE TO PRINCIPAL that appears after the signature lines in this form. Before acting on behalf of the principal, the attorney(s)-in-fact must sign this form acknowledging having read and understood the IMPORTANT NOTICE TO ATTORNEY(S)-IN-FACT that appears after the notice to the principal. PRINCIPAL (Name and Address of Person Granting the Power) ATTORNEY(S)-IN-FACT (Name and Address) SUCCESSOR ATTORNEY(S)-IN-FACT (Optional) To act if any named attorney-in-fact dies, resigns, or is otherwise unable to serve (Name and Address) First Successor Second Successor NOTICE: If more than one attorney-in-fact is designated to act at the same time, make a check or "x" on the line in front of one of the following statements: Each attorney-in-fact may independently exercise the powers granted. All attorneys-in-fact must jointly exercise the powers granted. EXPIRATION DATE (Optional) Use Specific Month Day , Year Only American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 5 Page 2 of 5 Minnesota Uniform Conveyancing Blanks Form 100.1.1 I (the above named Principal) appoint the above named Attorney(s)-in-Fact to act as my attorney(s)-in-fact: FIRST: To act for me in any way that I could act with respect to the following matters, as each of them is defined in Minnesota Statutes, section 523.24: (To grant to the attorney-in-fact any of the following powers, make a check or "x" on the line in front of each power being granted. You may, but need not, cross out each power not granted. Failure to make a check or "x" on the line in front of the power will have the effect of deleting the power unless the line in front of the power of (N) is checked or "x"-ed.) Check or "x" (A) real property transactions; I choose to limit this power to real property in follows: (Use legal description. Do not use street address.) County, Minnesota, described as (If more space is needed, continue on the back or on an attachment.) (B) tangible personal property transactions; (C) bond, share, and commodity transactions; (D) banking transactions; (E) business operating transactions; (F) insurance transactions; (G) beneficiary transactions; (H) gift transactions; (I) fiduciary transactions; (J) claims and litigation; (K) family maintenance; (L) benefits from military service; (M) records, reports, and statements; (N) all of the powers listed in (A) through (M) above and all other matters, other than health care decisions under a health care directive that complies with Minnesota Statutes, chapter 145C. SECOND: (You must indicate below whether or not this Power of Attorney will be effective if you become incapacitated or incompetent. Make a check or "x" on the line in front of the statement that expresses your intent.) This power of attorney shall continue to be effective if I become incapacitated or incompetent. This power of attorney shall not be effective if I become incapacitated or incompetent. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 5 Minnesota Uniform Conveyancing Blanks Form 100.1.1 THIRD: My attorney(s)-in-fact MAY NOT make gifts to the attorney(s)-in-fact, or anyone the attorney(s)-in-fact are legally obligated to support, UNLESS I have made a check or an "x" on the line in front of the second statement below and I have written in the name(s) of the attorney(s)-in-fact. The second option allows you to limit the gifting power to only the attorney(s)-in-fact you name in the statement. Minnesota Statutes, section 523.24, subdivision 8, clause (2), limits the annual gift(s) made to my attorney(s)-in-fact, or to anyone the attorney(s)-in-fact are legally obligated to support, to an amount, in the aggregate, that does not exceed the federal annual gift tax exclusion amount in the year of the gift. I do not authorize any of my attorney(s)-in-fact to make gifts to themselves or to anyone the attorney(s)-in-fact have a legal obligation to support. I authorize ____________________________________________________________________________________________, as my attorney(s)-in-fact, to make gifts to themselves or to anyone the attorney(s)-in-fact have a legal obligation to support. FOURTH: (You may indicate below whether or not the attorney-in-fact is required to make an accounting. Make a check or "x" on the line in front of the statement that expresses your intent.) My attorney-in-fact need not render an accounting unless I request it, or the accounting is otherwise required by Minnesota Statutes, section 523.21. My attorney-in-fact must render me or (Monthly, Quarterly, Annual) (Name and Address) (write in name(s)) accountings to during my lifetime, and a final accounting to the personal representative of my estate, if any is appointed, after my death. In Witness Whereof I have hereunto signed my name this day of , . (Signature of Principal) ACKNOWLEDGEMENT OF PRINCIPAL State of Minnesota, County of This instrument was acknowledged before me on , by (month/day/year) (insert name of Principal) . (Stamp) (signature of notarial officer) Title (and Rank): My commission expires: (month/day/year) American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 5 Minnesota Uniform Conveyancing Blanks Form 100.1.1 ACKNOWLEDGEMENT OF NOTICE TO ATTORNEY(S)-IN-FACT AND SPECIMEN SIGNATURE OF ATTORNEY(S)-IN-FACT. By signing below, I acknowledge I have read and understand the IMPORTANT NOTICE TO ATTORNEY(S)-IN-FACT required by Minnesota Statutes, section 523.23, and understand and accept the scope of any limitations to the powers and duties delegated to me by this instrument. (Notarization not required) THIS INSTRUMENT WAS DRAFTED BY: (insert name and address) Specimen signature of Attorney(s)-in-Fact (Notarization not required) IMPORTANT NOTICE TO THE PRINCIPAL READ THIS NOTICE CAREFULLY. The power of attorney form that you will be signing is a legal document. It is governed by Minnesota Statutes, chapter 523. If there is anything about this form that you do not understand, you should seek legal advice. PURPOSE: The purpose of the power of attorney is for you, the principal, to give broad and sweeping powers to your attorney(s)-infact, who is the person you designate to handle your affairs. A