PART III.
STATUTORY FORMS
[§551E‑51] Statutory form power of
attorney. A document substantially in the following form may be used to
create a statutory form power of attorney that has the meaning and effect
prescribed by this chapter.
STATE OF HAWAII
STATUTORY FORM POWER OF ATTORNEY
IMPORTANT INFORMATION
This 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 to your
property, including your money, whether or not you are able to act for
yourself. The meaning of authority over subjects listed on this form is
explained in the Uniform Power of Attorney Act in chapter 551E, Hawaii Revised
Statutes.
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 will
continue until you die or revoke the power of attorney or the agent resigns or
is unable 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 name a co-agent in the
Special Instructions. Co-agents are not required to act together unless you
include that requirement in the 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.
You may also name a second successor agent.
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.
DESIGNATION OF AGENT
I ______________________________ name the
following person
(Name of Principal)
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 AUTHORITY
I grant my agent and any successor agent
general authority to act for me with respect to the following subjects as
defined in the Uniform Power of Attorney Act in chapter 551E, Hawaii Revised
Statutes.
(INITIAL each subject you want to include in
the agent's general authority. If you wish to grant general authority 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 Subjects
GRANT OF SPECIFIC AUTHORITY (OPTIONAL)
My agent MAY 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
your property or change how your property is distributed at your death. INITIAL
ONLY the specific authority you WANT to give your agent.)
(_____) Create,
amend, revoke, or terminate an inter vivos trust
(_____) Make
a gift, subject to the limitations of the Uniform Power of Attorney Act under
section 551E‑47, Hawaii Revised Statutes, and any special instructions in
this power of attorney
(_____) Create
or change rights of survivorship
(_____) Create
or change a beneficiary designation
(_____) 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 retirement plan
(_____) Exercise
fiduciary powers that the principal has authority to delegate
LIMITATION ON AGENT'S AUTHORITY
An agent that is not my ancestor, spouse, or
descendant MAY NOT use my property to benefit the agent or a person to whom the
agent owes an obligation of support unless I have included that authority in
the Special Instructions.
SPECIAL INSTRUCTIONS (OPTIONAL)
You may give special instructions on the
following lines:
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
EFFECTIVE DATE
This 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 my person, 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 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
it has terminated or is invalid.
SIGNATURE AND
ACKNOWLEDGMENT
____________________________ _______________________
Your Signature Date
_________________________________________________________
Your Name Printed
_________________________________________________________
Your Address
_________________________________________________________
Your Telephone Number
State of _________________________________
County of _____________________________________
This document was acknowledged before me on
___________________________ ,
(Date)
by _____________________________________________________
(Name of Principal)
_________________________________ (Seal, if
any)
Signature of Notary
My commission expires: ________________________
This document prepared by:
_________________________________________________________
_________________________________________________________
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 you and
the principal. This relationship imposes upon you legal duties that continue
until you resign 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 you do 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 name of the principal and
signing 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:
(1) Act loyally for the principal's benefit;
(2) Avoid conflicts that would impair your ability to
act in the principal's best interest;
(3) Act with care, competence, and diligence;
(4) Keep a record of all receipts, disbursements, and
transactions made on behalf of the principal;
(5) Cooperate with any person that has authority to
make health care decisions for the principal to do what 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 is consistent with the principal's
best interest.
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 under this power of attorney. Events that terminate a power of
attorney or your authority to act under a power of attorney include:
(1) Death of the principal;
(2) The principal's revocation of the power of
attorney or your authority;
(3) The occurrence of a termination event stated in
the power of attorney;
(4) The purpose of the power of attorney is fully
accomplished; or
(5) If you are married to the principal, a legal
action is filed with a court to end your marriage, or for your legal
separation, unless the Special Instructions in this power of attorney state
that such an action will not terminate your authority.
Liability of Agent
The meaning of the authority granted to you is
defined in the Uniform Power of Attorney Act, in chapter 551E, Hawaii Revised
Statutes. If you violate the Uniform Power of Attorney Act in chapter 551E,
Hawaii Revised Statutes, or act outside 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 legal advice.
[L 2014, c 22, pt of §1]
