EFTA01295252.pdf

Private Wealth Management
Hc:titsche Bank
Durable General Power of Attorney
New York Statutory Short Form
The powers you grant below continue to be effective should you become disabled or incompetent:
CAUTION TO THE PRINCIPAL: Your Power of Attorney is an important document. As the-principal,' you give the person who you
choose (your "agent) authority to spend your money and sell or dispose of your property during your lifetime without telling you.
You do not lose your authority to act even though you hove given your agent similar authority.
When your agent exercises this authority, he or she must act according to any instructions you have provided or, where there ore
no specific instructions, in your best interest. "IMPORTANT INFORMATION FOR THE AGENT' at the end of this document describes
your agent's responsibilities.
Your agent can act on your behalf only after signing the Power of Attorney before a notary public.
You con request information from your agent at any time. if you are revoking a prior Power of Attorney by executing this Power of
Attorney, you should provide written notice of the revocation to your prior agents/ and to the financial institution where your
accounts are located.
You con revoke or terminate your Power of Attorney at any time for any reason as long as you are of sound mind. If you ore no
longer of sound mind, a court can removean agent for acting improperty.
Your agent cannot make health care decisions for you. You may execute a 'Health Care Proxy to do this.
The low governing Powers of Attorney is contained in the New York General Obligations Law, Article 5, Title IS. This law is
available at a law library, or online through the New York State Senate or Assembly websites, www.senote.Stote.ny.us or www.
assembly.state.ny.us.
If there is anything about this document that you do not understand, you should ask a lawyer of your own choosing to explain it to
you.
DESIGNATION OF AGENT(S):
JeffLeybstein, 6100 fieSIBACKQUIELeinThOrnaL1).51,ff4OR42
_npaeby.appol.nt:_
(Insert your name and address)
Darren Indyic
ac.alyan-
(Insert name(s) and address(es) of agent(5))
If you designate more than one agent above, they must act TOGETHER unless you INITIAL the statement below.
My agents may act SEPARATELY.
DESIGNATION OF SUCCESSOR AGENT(S): (OPTIONAL)
If every agent designated above is unable or unwilling to serve, I appoint as my successor agent(s):
(Insert name(s) and address(es) of successor agent(s))
Successor agents designated above must act TOGETHER unless you INITIAL the statement below.
My successor agents may act SEPARATELY.
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This POWER OR ATTORNEY shall not be affected by my subsequent incapacity unless I have stated otherwise below, under
-MODIFICATIONS?
This POWER OF ATTORNEY REVOKES any and all prior Powers of Attorney executed by me unless I have stated otherwise
below, under 'MODIFICATIONS.'
If you are NOT revoking your prior Powers of Attorney, and if you are granting the same authority In two or more Powers of
Attorney, you must also Indicate under "MODIFICATIONS' whether the agents given these powers are to act together or
separately.
GRANT OF AUTHORITY:
(DIRECTIONS To grant your agent some or all of the authority below, either (I) INITIAL the line to the left of each authority you
grant or (2) write or type the letters for each authority you grant on the blank line at (P), and INMAL the line to the left of each
authority you grant at (P). If you INITIAL (P), AND enter the desired letters from (A) through (0) you do not need to INITIAL the
other lines)
I grant authority to my agent(s) with respect to the following subjects as defined in sections 5-1502A through 5-1502N of the
New York General Obligations Lane
(A) real estate transactions;
(B) chattel and goods transactions;
— ro bond, share, and commodity transactions
(0) banking transactions
(E) business operating transactions;
(F) insurance transactions;
(G) estate transactions;
(H) claims and litigation;
11) personal and family maintenance;
0) benefits from governmental programs or civil or military servke;
(K) health care billing and payment matters; records, reports, and statements;
(L) retirement benefit transactions;
(M) tax matters;
(N) all other matters;
_(0) full and unqualified authority to my agent(s) to delegate any or all of the foregoing powers to any person
or persons whom my agent(s) select A-O
EACH of the matters identified by the following letters:
riot INITIAL the other lines Ify ou Initiall ine (P)AND enter the desired letters from (A) through (0)).
MODIFICATIONS:
The following modifications supplement the authority I have granted to my agent(s):
Grant of Authority;
Letter (C), bond. share, and commodity transactions, under "GRANT OF AUTHORITY' shall be supplemented to
Include the following authority:
0) opening and closing brokerage accounts in my name; and
pi) providing trading instructions with respect to all assets in the brokerage accounts; and
MO withdrawing assets from, or depositing assets Into, brokerage accounts.
2. Letter (D), 'banking transactions,' under "GRANT OF AUTHORITY" shall be supplemented to include the following
authority:
(I) borrowing money on such terms and with such security as my attorney-In-fact may decide In his/her sole discretion
and executing all promissory notes, security agreements, mortgages, and other instruments relating thereto; and
(10 accessing safe deposit boxes or other places of safekeeping standing In my name alone or jointly with another and
removing the contents and making additions thereto; and
00) opening and closing checking, savings, money market, and certificate of deposit accounts In my name and
withdrawing funds from the foregoing or adding funds to the foregoing
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Revocation:
1. Although this document revokes all powers of attorney I have previously executed this document shall not revoke any
powers of attorney previously executed by me for a specific or limited purpose, unless I have specified otherwise
herein. It shall not revoke any power executed as part of a contract I signed or for the management of any bank or
securities account. In order to revoke a prior power of attorney for a specific or limited purpose, I will execute a
revocation specifically referring to the power to be revoked.
2. This power of attorney shall not be revoked by any subsequent power of attorney I may execute, unless such
subsequent power specifically provides that it revokes this power by referring to the date of my execution of this
document.
3. Whenever two or more powers of attorney are valid at the same time, the agents appointed on each shall act
separately, unless specified differently in the documents.
Additional Modifications: (OPTIONAL)
In this section, you may make additional provisions. including language to limit or supplement authority granted to your
agent.
However, you cannot use this MODIFICATIONS section to grant your agent authority to make major gifts or changes to
interests in your property. If you wish to grant your agent such authority, you MUST complete the Statutory Major Gifts Rider.
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MAJOR GIFTS AND OTHER TRANSFERS: STATUTORY MAJOR GIFTS RIDER (OPTIONAL)
in order to authorize your agent to make major gifts and other transfers of your property, you must INMAL the statement
below AND execute a Statutory Major Gifts Rider at the same time as this instrument. Initialing the statement below by Itself
does not authorize your agent to make major gifts and other transfers. The preparation of the Statutory Major Gifts Rider
should be supervised by a lawyer.
(SMGR) I grant my agent authority to make major gifts and other transfers of my property, In accordance with the
terms and conditions of the Statutory Major Gifts Rider that supplements this Power of Attorney.
DESIGNATION OF MONITOR(S): (OPTIONAL)
I designate the following as monitor(s):
(Insert name and address)
(Insert name and address)
Upon the request of the monitor(s), my agent(s) must provide the monItot(s) with a copy of the power of attorney and a
record of al transactions done or made on my behalf. Third parties holding records of such transactions shall provide the
records to the monitor(s) upon request.
COMPENSATION OF AGENT(S): (OPTIONAL)
Your agent is entitled to be reimbursed from your assets for reasonable expenses incurred on your behalf. If you ALSO wish your
agent(s) to be compensated from your assets for services rendered on your behalf, INITIAL the statement below. If you wish to
define -reasonable compensation: you may do so above, under 'MODIFICATIONS'
My agent(s) shall be entitled to reasonable compensation for services rendered.
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ACCEPTANCE BY THIRD PARTIES:
I agree to Indemnify any third party for any claims that may arise against the third party because of reliance on this Power of
Attorney. I understand that any termination of this Power of Attorney, whether the result of my revocation of the Power of
Attorney or otherwise, is not effective as to a third party until the third party has actual notice or knowledge of the
termination.
TERMINATION:
This Power of Attorney continues until I revoke it or it is terminated by my death or other event described in section 5-1511
of the General Obligations Law.
Section 5-1511 of the General Obligations taw descrkes the manner In whkh you may revoke your Power of Attorney, and the
events which terminate the Power of Attorney.
SIGNATURE AND ACKNOWLEDGEMENT:
(4
In Witness Whereof I have hereunto signed my name on the IS tot Mayan, .20
(YOU SIGN HERE)
ignatstre,tdrrif>iand
ACKNOWLEDGEMENT IN NEW YORK STATE
STATE OF NEW YORK
1\t l ) ss.:
COUNTY OF
On the day otan the yeaefore me, the undersigadarsggally aPPeared tv..WerieV Griftles
personally known to me or proved to me on the basis of satisfactory evidence to be the indMdual whose name Is subscribed
to the within Instrument and acknowledged to me that he/she executed the same in his/her capacity, and that by his/her
signature the Instrument. • Individual, or the person upon behalf of which the individual acted, executed the
m
eta the talcInn
rI OFF
ACKNOWLEDGEMENT OUTSIDE NEW YORK STATE Notwy Public • State 01 New York •
Idly NO. O1GR82857OO
STATE OF 4 Qualified in New York County
st.: I My Commission Expires Jul 8, 2017 0
COUNTY OF NY rerilluirennnerellsib
204
On thel3rI of the year , before Me, the undersigned, personally appeared , personally
known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the
within Instrument and acknowledged to me that he/she executed the same In his/her capacity, and that by his/her signature
on the Instrument, the individual, or the person upon behalf of which the individual acted, executed the Instrument, and that
such IndNidkal made such appearance before the undersigned in
IndNIdual taking ack
"4sae llrf GROFF
Notary Public - State of New York
NO. O1GR62857OO
Oualltied in New Yak County
My Commission Expires Jul O. 2017 4
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IMPORTANT INFORMATION FOR THE AGENT:
When you accept the authority granted under this Power of Attorney, a special legal relationship is created between you and
the principal. This relationship imposes on you legal responsibilities that continue until you resign or the Power of Attorney
is terminated or revoked. You must
(1) act according to any instructions from the principal, or, where there are no instructions, in the principal's best
Interest
(2) avoid conflicts that would impair your ability to act in the principal' best interest.
(3) keep the principal's property separate and distinct from any assets you own or control, unless otherwise permitted by
law;
(4) keep a record of all receipts, payments, and transactions conducted for the principal; and
(5) disclose your identity as an agent whenever you act for the principal by writing or printing the principal's name and
signing your own name as -agent" in either of the following manner: (Principal's Name) by (Your Signature) as
Agent or (Your Signature) as Agent for (Principal's Name).
You may not use the principal's assets to benefit yourself or give major gifts to yourself or anyone else unless the principal
has specifically granted you that authority in this Power of Attorney or in a Statutory Major Gifts Rider attached to this Power
of Attorney. If you have that authority, you must act according to any instructions of the principal or, where there are no such
instructions, In the principal's best Interest. You may resign by giving written notice to the principal and to any co-agent,
successor agent, monitor if one has been named in this document, or the principal's guardian if one has been appointed If
there is anything about this document or your responsibilities that you do not understand, you should seek legal advice.
Liability of Agent The meaning of the authority given to you is defined in New York's General Obligations Law, Article 5, Title
15. If it is found that you have violated the law or acted outside the authority granted to you in the Power of Attorney, you
may be liable under the law for your violation.
AGENTS SIGNATURE AND ACKNOWLEDGEMENT OF APPOINTMENT:
It is not required that the principal and the agent(s) sign at the same time, nor that multiple agents sign at the same time.
vwe. Darren Indyke, 2 Kean Court, Livingston, NJ 07039
(Insert name(s) and addresses of agent(s))
(Insert name(s) and addresses of agent(s))
have read the foregoing Power of Attorney.
I ant/we are the person(s) identified therein as agent(s) for the principal named therein.
l/we acknowledge my/our legal responsibilities.
Agent(s) sign(s) here:
Signatur Signature:
Darren Indyke
Name: Name:
ACKNOWLEDGEMENT IN NEW YORK STATE
STATE OF NEW YORK
)ss
COUNTY Of N L 14/.)
on,
ye-tat
On the le day of in the year 2 ntt4 before me, the unaonally appeare r h....c9-11(C(personally
known to me or p roved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed
to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and
that by his/her/their signature(s) on the Instrument, the Individual(s), or the person upon behalf of which the individual(s)
acted, executed the Instrument.
YOLANDA RICHARDSON
Notary Public. State of New York
No O1R16053071
(Sidi lure and office of the individual taking acknowledgement) Qualified in Queens County
Commission Expires January 2. 20
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