633B.301 Power of attorney — form. A document substantially in the following form may be used to create a statutory power of attorney that has the meaning and effect prescribed by this chapter: IOWA STATUTORY POWER OF ATTORNEY FORM 1. POWER OF ATTORNEYThis 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 toyour property (including but not limited to your money) whether ornot you are able to act for yourself. The meaning of authority oversubjects listed on this form is explained in the Iowa Uniform Powerof Attorney Act, Iowa Code chapter 633B. 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 willcontinue until you die or revoke the power of attorney or the agentresigns or is unable to act for you. Your agent is not entitled to compensation unless you state otherwise in the optional Special Instructions. This form provides for designation of one agent. agentresigns or is unable to act for you. Your agent is not entitled to compensation unless you state otherwise in the optional Special Instructions. This form provides for designation of one agent. If you wish to name more than one agent, you may name a coagent in the optionalSpecial Instructions. Coagents must act by majority rule unless youprovide otherwise in the optional 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. Youmay also name a second successor agent. This power of attorney becomes effective immediately upon signature and acknowledgment unless you state otherwise in theoptional Special Instructions. If you have questions about this power of attorney or the authority you are granting to your agent, you should seek legaladvice 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 _________________________________ DESIGNATION OF SUCCESSOR AGENT(S) gent ____________________________________________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 AUTHORITY I grant my agent and any successor agent general authority to act for me with respect to the following subjects as defined in theIowa Uniform Power of Attorney Act, Iowa Code chapter 633B: Sat Dec 23 12:15:36 2023 Iowa Code 2024, Section 633B.301 (14, 0) §633B.301, POWERS OF ATTORNEY 2 (Initial each subject you want to include in the agent’s general authority. , Iowa Code chapter 633B: Sat Dec 23 12:15:36 2023 Iowa Code 2024, Section 633B.301 (14, 0) §633B.301, POWERS OF ATTORNEY 2 (Initial each subject you want to include in the agent’s general authority. If you wish to grant general authority over all of thesubjects you may initial 'All Preceding Subjects' instead of initialingeach 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 yourproperty or change how your property is distributed at your death.Initial only the specific authority you WANT to give your agent.) t the authority to take actions that could significantly reduce yourproperty or change how your property is distributed at your death.Initial only the specific authority you WANT to give your agent.) ___ Amend, revoke, or terminate a revocable inter vivos trust, if authorized by the trust. ___ Agree to the amendment or termination of any other inter vivos trust. ___ Make a gift to an individual who is not an agent, subject to the limitations of the Iowa Uniform Power of Attorney Act, IowaCode section 633B.217, and any special instructions in this powerof attorney. Make gifts, either direct or indirect, to my agent acting under this power of attorney as follows: ___ Any such gift must be approved in writing by ________________; or ___ No third-party approval is needed.___ 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 retirementplan. ___ Exercise fiduciary powers that the principal has authority to delegate. ___ Disclaim or refuse an interest in property, including a power of appointment. survivor benefit under a retirementplan. ___ 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 agentowes an obligation of support unless I have included that authorityin the optional Special Instructions. Sat Dec 23 12:15:36 2023 Iowa Code 2024, Section 633B.301 (14, 0) SPECIAL INSTRUCTIONS (OPTIONAL) You may give special instructions on the following hat authorityin the optional Special Instructions. Sat Dec 23 12:15:36 2023 Iowa Code 2024, Section 633B.301 (14, 0) SPECIAL INSTRUCTIONS (OPTIONAL) You may give special instructions on the following lines:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ shall have the authority to request an accounting of any agent. EFFECTIVE DATE This power of attorney is effective immediately upon signature and acknowledgment unless I have stated otherwise in the optionalSpecial Instructions. equest an accounting of any agent. EFFECTIVE DATE This power of attorney is effective immediately upon signature and acknowledgment unless I have stated otherwise in the optionalSpecial Instructions. NOMINATION OF CONSERVATOR AND GUARDIAN (OPTIONAL) If it becomes necessary for a court to appoint a conservator of my estate or guardian of my person, I nominate the following person(s)for appointment: Name of Nominee for Conservator 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 ATTORNEY Any person, including my agent, may rely upon the validity of this power of attorney or a copy of it unless that person knows ithas terminated or is invalid. SIGNATURE AND ACKNOWLEDGMENT _____________________________ _________________________ Your Signature Date _____________________________Your Name Printed__________________________________________________________Your Address_____________________________Your ___ _________________________ Your Signature Date _____________________________Your Name Printed__________________________________________________________Your Address_____________________________Your Telephone NumberState of ____________________County of ___________________This document was acknowledged before me on _______________(date), by __________________________ (name of principal)_____________________________ (Seal, if any) Signature of NotaryMy commission expires ________________This document prepared by______________________________________________________________________________________________________________________ Sat Dec 23 12:15:36 2023 Iowa Code 2024, Section 633B.301 (14, 0) §633B.301, POWERS OF ATTORNEY 4 2. 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 theprincipal and you. This relationship imposes upon you legal dutiesthat continue until you resign or the power of attorney is terminatedor revoked. You must do all of the following: Do what you know the principal reasonably expects you to do with the principal’s property or, if you do not know gn or the power of attorney is terminatedor revoked. You must do all of the following: Do what you know the principal reasonably expects you to do with the principal’s property or, if you do not know the principal’sexpectations, act in the principal’s best interest. Act in good faith.Do nothing beyond the authority granted in this power of attorney. Disclose your identity as an agent whenever you act for the principal by writing or printing the name of the principal andsigning your own name as agent in the following manner:_______________________ (principal’s name) by_______________________ (your signature) as Agent Unless the Special Instructions in this power of attorney state otherwise, you must also do all of the following: 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 do what you know theprincipal reasonably expects or, if you do not know the principal’sexpectations, l. Cooperate with any person that has authority to make health care decisions for the principal to do what you know theprincipal reasonably expects or, if you do not know the principal’sexpectations, to act in the principal’s best interest. Attempt to preserve the principal’s estate plan if you know the plan and preserving the plan is consistent with the principal’s bestinterest. 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 underthis power of attorney. Events that terminate a power of attorney oryour authority to act under a power of attorney include any of thefollowing: 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.If you are married to the principal, a legal action is filed with a court to end your marriage, or for your legal separation, unlessthe Special Instructions in this power of attorney state that such anaction will not terminate your authority. l action is filed with a court to end your marriage, or for your legal separation, unlessthe Special Instructions in this power of attorney state that such anaction will not terminate your authority. LIABILITY OF AGENT The meaning of the authority granted to you is defined in the Iowa Uniform Power of Attorney Act, Iowa Code chapter 633B. Ifyou violate the Iowa Uniform Power of Attorney Act, Iowa Codechapter 633B, or act outside the authority granted, you may be liablefor any damages caused by your violation. Sat Dec 23 12:15:36 2023 Iowa Code 2024, Section 633B.301 (14, 0) If there is anything about this document or your duties that you do not understand, you should seek legal advice. 2014 Acts, ch 1078, §43 Sat Dec 23 12:15:36 2023 Iowa Code 2024, Section 633B.301 (14, 0)
Iowa Legal Code