POWER OF ATTORNEY







Notice: THIS IS AN IMPORTANT DOCUMENT. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS. THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON WHOM YOU DESIGNATE (YOUR "AGENT" OR "ATTORNEY-IN-FACT) BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO PLEDGE, SELL, OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. YOU MAY SPECIFY THAT THESE POWERS WILL EXIST EVEN AFTER YOU BECOME DISABLED, INCAPACITATED, OR INCOMPETENT. THE POWERS THAT YOU GIVE YOUR AGENT ARE EXPLAINED MORE FULLY IN NEW YORK GENERAL OBLIGATIONS LAW, ARTICLE 5, TITLE 15, SECTIONS 5-1502A THROUGH 5-1503, WHICH EXPRESSLY PERMITS THE USE OF ANY OTHER OR DIFFERENT FORM OF POWER OF ATTORNEY DESIRED BY THE PARTIES CONCERNED. THIS DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL OR OTHER HEALTH CARE DECISIONS FOR YOU. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER TO EXPLAIN IT TO YOU.


Know Everyone by These Presents, , which are intended to constitute a GENERAL POWER OF ATTORNEY pursuant to Article 5, Title 15 of the New York General Obligations Law:

That I,__________________________________________________________,
do hereby (insert name and address of the principal) appoint:

__________________________________________________________________

__________________________________________________________________

(If 1 person is to be appointed agent, insert the name and address of the agent above)

(If 2 or more persons are to be appointed agents with each agent to be able to act ALONE without requiring the consent of any other agent appointed in order to act, insert the name and address above of each agent SEPARATELY appointed and BE SURE TO insert the word "OR" between EACH designation of an agent to show that EACH agent has COMPLETE power to act alone)

(If 2 or more persons are to be appointed agents to act TOGETHER and requiring the JOINT consent of ALL appointed agents to act with no one agent to be able to act alone, insert the names and addresses above of all agents JOINTLY appointed and BE SURE TO insert the word "AND" between EVERY designation of each agent to indicate that ALL agents listed are to act together and NONE can act alone)

MY ATTORNEY(S)-IN-FACT TO ACT

(If more than one agent is designated and the principal wants each agent alone to be able to exercise the power conferred, insert in this blank the word "SEPARATELY")

(If more than one agent is designated and the principal wants all of the designated agents together to exercise the power conferred, insert in this blank the word "JOINTLY") (The failure to make any insertion in this blank will require the agents to act either separately or jointly, in accordance with the principals use of the word "OR " or the other word "AND " between every respective designation of such agents above. If the principal's wishes cannot be determined because he or she fails to insert the word "OR", "AND", "SEPARATELY", or "JOINTLY" as he or she is asked to do above, the principal will be deemed to require the agents designated above to act jointly)

IN MY NAME, PLACE AND STEAD in any way which I myself could do, if I were personally present, with respect to the following matters as each of them is defined in Title 15 of Article 5 of the New York General Obligations Law to the extent that I am permitted by law to act through an agent:

Initial in the opposite box any one or more of the subdivisions as to which the principal WANTS to give the agent authority.

(NOTICE: The principal must write his or her initials in the corresponding blank space of a box below with respect to each of the subdivisions (A) through (N) below for which the principal WANTS to give the agent(s) authority. If the blank space within a box for any particular subdivision is NOT initialed, NO AUTHORITY WILL BE GRANTED for matters that are included in that subdivision)

To induce any third party to act hereunder, I hereby agree that any third party receiving a duly executed copy or facsimile of this instrument may act hereunder, and that revocation or termination hereof shall be ineffective as to such third party unless and until actual notice or knowledge of such revocation or termination shall have been received by such third party, and I for myself and for my heirs, executors, legal representatives and assigns, hereby agree to indemnify and hold harmless any such third party from and against any and all claims that may arise against such third party by reason of such third party having relied on the provisions of this instrument.

As set forth in Article 5, Section 1504 of the General Obligations Law of the State of New York: 5-1504. Acceptance of statutory short form power of attorney

  1. No bank, trust company, national bank, savings bank, federal mutual savings bank located in this state, savings and loan association, federal savings and loan association, federal mutual savings and loan association, credit union or federal credit union or branch of a foreign banking corporation (each of the foregoing referred to in this section as "banking institution"), public pension fund or retirement system located in this state shall refuse to honor a statutory short form power of attorney properly executed in accordance with section 5-1501 of this title.

  2. The failure of a banking institution, public pension fund or retirement system to honor a properly executed statutory short form power of attorney shall be deemed unlawful.

  3. No banking institution, public pension fund or retirement system receiving and retaining a statutory short form power of attorney presented to it as provided in Subdivision one of this section nor any officer, agent or employee of such institution shall concur any liability by reason of acting upon the authority thereof unless the institution shall have actually received, at the office where the account is located, written notice of the revocation or termination of such power of attorney.

  4. If the application of the provisions of subdivision one or two of this section shall be held invalid to any banking institution, public pension fund or retirement system the application of such provisions to any other banking institution, public pension fund or retirement system other than those to which it is held invalid, shall not be affected thereby.

In Witness Whereof, I have hereunto signed my name and affixed my seal on this day of ,20__.

(Seal)

____________________________
(Signature of Principal)

ACKNOWLEDGEMENTS

STATE OF NEW YORK
COUNTY OF ss.:

On 20__, before me personally came to me known, and known to me to be the individual described in, and who executed the foregoing instrument, and (s)he acknowledged to me that (s)he executed the same.

_____________________________________ NOTARY PUBLIC STATE OF NEWYORK COUNTY OF ONEIDA MY COMM EXPIRES   /  /

AFFIDAVIT THAT POWER OF ATTORNEY IS IN FULL FORCE (Sign before a notary public)

STATE OF NEW YORK COUNTY OF ONEIDA ss.:

being duly sworn, deposes and says:

  1. The Principal within did, in writing, appoint me as the Principal's true and lawful ATTORNEY(S)- IN-FACT in the within Power of Attorney.

  2. I have no actual knowledge or actual notice of revocation or termination of the Power of Attorney by death or otherwise, or knowledge of any facts indicating the same. I further represent that the Principal is alive, has not revoked or repudiated the Power of Attorney and the Power of Attorney still is in full force and effect.

  3. I make this affidavit for the purpose of inducing to accept delivery of the following instrument (s), as executed by me in my capacity as the ATTORNEY(S)-IN-FACT, with full knowledge that this affidavit will be relied upon in accepting the execution and delivery of the Instrument(s) and in paying good and valuable consideration therefor:

    ____________________________________________

Sworn to me on the day of , 20__.

___________________________
Notary Public State of New York
County of Oneida
My Comm Expires June 30, 20__



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Last Updated: April 21, 2005

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