Alaska General Durable Power of Attorney for Property & Finances (Upon Disability)

Alaska General Durable Power of Attorney
for Property & Finances (Upon Disability)

GENERAL POWER OF ATTORNEY

(Alaska Statutory Form Power of Attorney — AS 13.26.645)

Effective Only Upon the Incapacity of the Principal — Springing

(Alaska Statutes Title 13, Chapter 13.26, Article 5 — Statutory Form Power of Attorney)

THE POWERS GRANTED FROM THE PRINCIPAL TO THE AGENT OR AGENTS IN THE FOLLOWING DOCUMENT ARE VERY BROAD. THEY MAY INCLUDE THE POWER TO DISPOSE, SELL, CONVEY, AND ENCUMBER YOUR REAL AND PERSONAL PROPERTY. ACCORDINGLY, THE FOLLOWING DOCUMENT SHOULD ONLY BE USED AFTER CAREFUL CONSIDERATION. IF YOU HAVE ANY QUESTIONS ABOUT THIS DOCUMENT, YOU SHOULD SEEK COMPETENT ADVICE. YOU MAY REVOKE THIS POWER OF ATTORNEY AT ANY TIME.

Section 1. Designation of Agent

Pursuant to AS 13.26.600, 13.26.625 - 13.26.640, and 13.26.655 - 13.26.695, I,

________________________________

(Name of principal)

of

________________________________

(Address of principal)

do hereby appoint

________________________________

(Name and address of agent)

Telephone of agent (optional): ________________________________

If you wish to name a second person to serve at the same time as an agent, complete the following (otherwise leave blank):

________________________________

(Name and address of second agent)

Telephone of second agent (optional): ________________________________

my agent(s) to act as indicated below 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 AS 13.26.665, to the full extent that I am permitted by law to act through an agent:

A public home care provider who is paid with state funds to serve you may not accept appointment as your agent unless another person who is not a public home care provider is appointed to serve jointly (AS 13.26.630; AS 47.05.017(c)).

Section 2. More Than One Agent

IF YOU HAVE APPOINTED MORE THAN ONE AGENT, MARK ONE OF THE FOLLOWING:

☐ Each agent may exercise the powers conferred separately, without the consent of any other agent.

☐ All agents shall exercise the powers conferred jointly, with the consent of all other agents.

If you name more than one agent and mark neither box, Alaska law requires them to act jointly (AS 13.26.660(1)).

Section 3. Powers Granted

MARK THE BOXES BELOW TO INDICATE THE POWERS YOU WANT TO GIVE YOUR AGENT OR AGENTS. MARK THE BOX FOR "YES" THAT IS OPPOSITE A CATEGORY BELOW TO GIVE YOUR AGENT OR AGENTS THE POWER IN THAT CATEGORY. IF YOU DO NOT MARK A BOX OPPOSITE A CATEGORY, YOUR AGENT OR AGENTS WILL NOT HAVE THE POWER IN THAT CATEGORY.

YES

☐ (A) real estate transactions

☐ (B) transactions involving tangible personal property, chattels, and goods

☐ (C) bonds, shares, and commodities transactions

☐ (D) banking transactions

☐ (E) business operating transactions

☐ (F) insurance transactions

☐ (G) estate transactions

☐ (H) retirement plans

☐ (I) claims and litigation

☐ (J) personal relationships and affairs

☐ (K) benefits from government programs and civil or military service

☐ (L) records, reports, and statements

☐ (M) voter registration and absentee ballot requests

☐ (N) all other matters, including those specified as follows:

________________________________

Checking a category gives your agent the full authority described for that category in AS 13.26.665, which can include selling or encumbering property.

Section 4. Grant of Specific Authority (Optional)

The agent or agents you have appointed WILL NOT have the power to do any of the following acts UNLESS you MARK the box opposite that category:

☐ create, amend, revoke, or terminate an inter vivos trust;

☐ make a gift, subject to the limitations of AS 13.26.665(q) and any special instructions in this power of attorney;

☐ create or change a beneficiary designation;

☐ revoke a transfer on death deed made under AS 13.48;

☐ create or change rights of survivorship;

☐ delegate authority granted under the 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;

☐ exercise authority over the content of electronic communications, as that term is defined in 18 U.S.C. 2510(12), sent or received by the principal.

Section 5. When This Document Is Effective

TO INDICATE WHEN THIS DOCUMENT SHALL BECOME EFFECTIVE, MARK ONE OF THE FOLLOWING:

☐ This document shall become effective upon the date of my signature.

☒ This document shall become effective upon the date of my incapacity and shall not otherwise be affected by my incapacity.

This is the springing version of the form: the effectiveness election above is pre-marked. Do not change it. This power of attorney becomes effective only when your incapacity is established by the affidavit in Exhibit A, completed and sworn as required by AS 13.26.680 — not by the signing of this document.

Notice of Revocation of the Powers Granted in This Document

You may revoke one or more of the powers granted in this document. Unless otherwise provided in this document, you may revoke a specific power granted in this power of attorney by completing a special power of attorney that includes the specific power in this document that you want to revoke. Unless otherwise provided in this document, you may revoke all the powers granted in this power of attorney by completing a subsequent power of attorney.

Notice to Third Parties

A third party who relies on the reasonable representations of an agent as to a matter relating to a power granted by a properly executed statutory form power of attorney does not incur any liability to the principal or to the principal's heirs, assigns, or estate as a result of permitting the agent to exercise the authority granted by the power of attorney. A third party who fails to honor a properly executed statutory form power of attorney may be liable to the principal, the agent, the principal's heirs, assigns, or estate for a civil penalty, plus damages, costs, and fees associated with the failure to comply with the statutory form power of attorney. If the power of attorney is one which becomes effective upon the incapacity of the principal, the incapacity of the principal is established by an affidavit, as required by law.

Optional Provisions

YOU MAY DESIGNATE AN ALTERNATE AGENT. ANY ALTERNATE YOU DESIGNATE WILL BE ABLE TO EXERCISE THE SAME POWERS AS THE AGENT(S) YOU NAMED AT THE BEGINNING OF THIS DOCUMENT. IF YOU WISH TO DESIGNATE AN ALTERNATE OR ALTERNATES, COMPLETE THE FOLLOWING:

If the agent(s) named at the beginning of this document is unable or unwilling to serve or continue to serve, then I appoint the following agent to serve with the same powers:

First alternate or successor agent

________________________________

(Name and address of alternate)

Second alternate or successor agent

________________________________

(Name and address of alternate)

YOU MAY NOMINATE A GUARDIAN OR CONSERVATOR. IF YOU WISH TO NOMINATE A GUARDIAN OR CONSERVATOR, COMPLETE THE FOLLOWING:

In the event that a court decides that it is necessary to appoint a guardian or conservator for me, I hereby nominate

________________________________

(Name and address of guardian or conservator)

to be considered by the court for appointment to serve as my guardian or conservator, or in any similar representative capacity.

Health Care Directive Cross-Reference (Optional)

☐ I have executed a separate declaration under AS 13.52 known as an "Alaska Advance Health Care Directive."

☐ I have not executed an "Alaska Advance Health Care Directive."

This document does not authorize anyone to make health-care decisions for you. Health-care decisions are made under a separate Alaska Advance Health Care Directive (AS 13.52).

Optional Additional Provisions (AS 13.26.670)

Not part of the statutory form text. You may add provisions that are not substantially inconsistent with the statutory form (AS 13.26.670). If none, leave blank.

________________________________

________________________________

________________________________

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Section 6. Signatures

Sign this document before a notary public or other officer authorized to take acknowledgments. Witnesses are not required under Alaska law.

IN WITNESS WHEREOF, I have hereunto signed my name this ________ day of ____________________, ______.

________________________________

(Signature of principal)

State of ____________________

________ Judicial District (or County of ____________________ or Municipality of ____________________)

Acknowledged before me at ________________________________ on ____________________ by ________________________________ (name of person who acknowledged).

________________________________

(Signature of officer or notary)

Title or rank: ____________________ Serial number, if any: ____________________

My commission expires: ____________________ [Seal]

SIGNATURE BY ANOTHER PERSON AT THE PRINCIPAL'S DIRECTION (OPTIONAL)

If a person other than the principal executes the signature for the principal, the person may not be a person who is appointed an agent in the power of attorney, and the following signature line and notary verification must also be completed:

IN WITNESS WHEREOF, I have hereunto signed my name this ________ day of ____________________, ______.

________________________________

(Signature of person signing at the request of ________________________________, the principal)

Printed name of person signing ________________________________

Form of identification of person signing ________________________________

State of ____________________

________ Judicial District (or County of ____________________ or Municipality of ____________________)

Acknowledged before me at ________________________________ on ____________________ by ________________________________ (name of person who acknowledged).

________________________________

(Signature of officer or notary)

Title or rank: ____________________ Serial number, if any: ____________________

My commission expires: ____________________ [Seal]

Translation Clause (If Needed)

I certify that I have translated the provisions of the foregoing Power of Attorney from the English language to the ____________________________ language to the best of my ability.

________________________________ Dated: ____________________

(Translator)

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Exhibit A — Affidavit Establishing Incapacity of Principal (AS 13.26.680)

This affidavit activates the attached springing power of attorney. DO NOT complete it when the principal signs the power of attorney. It is completed and sworn only if and when the principal's incapacity must be established. Alaska law requires incapacity to be established by affidavit (AS 13.26.680); third parties may rely on it.

Principal: ________________________________ Date of power of attorney: ____________________

The undersigned state(s) that the principal is unable to manage property or business affairs because the principal (MARK ONE):

☐ (A) has an impairment in the ability to receive and evaluate information or make or communicate decisions even with the use of technological assistance, and this impairment is the result of mental illness, mental deficiency, physical illness, physical disability, advanced age, use of drugs, chronic intoxication, or other similar medical or psychological reason, to such an extent that the principal is unable to manage the principal's property or affairs; or

☐ (B) is (i) missing; (ii) detained, including incarcerated in a penal system; or (iii) outside the United States and unable to return.

If (A) is marked: TWO physicians or similarly qualified medical professionals who have personally examined the principal must sign below (AS 13.26.680(a)(2)). EXCEPTION: the affidavit may be signed by only one physician or similarly qualified medical professional if only one is available — in that case the signer MUST mark the following statement, and only Affiant 1 signs:

☐ Only one physician or similarly qualified medical professional is available.

If (B) is marked: physician signatures are NOT required; only Affiant 1 signs (a person with personal knowledge of the facts).

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AFFIANT 1

________________________________

(Signature of Affiant 1)(Date)

Printed name: ________________________________

If branch (A) is marked — profession and license no.: ________________________________

Date(s) of personal examination of the principal (branch (A)): __________________________

Basis of knowledge (branch (B)): ________________________________

AFFIANT 2 (required only if branch (A) is marked and the one-available box is NOT marked)

________________________________

(Signature of Affiant 2)(Date)

Printed name: ________________________________

Profession and license no.: ________________________________

Date(s) of personal examination of the principal: ________________________________

Subscribed and sworn to or affirmed before me at ________________________________ on ____________________ by ________________________________ (name of person making statement).

________________________________

(Signature of officer or notary)

Title or rank: ____________________ Serial number, if any: ____________________

My commission expires: ____________________ [Seal]

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Exhibit B — Agent's Certification (AS 13.26.615(a)(1)); Agent's Affidavit of Nonrevocation (AS 13.26.625(b))

A third party asked to accept the power of attorney may request, and may rely upon without further investigation, an agent's certification under penalty of perjury of any factual matter concerning the principal, the agent, or the power of attorney (AS 13.26.615(a)(1)). This exhibit supplies that certification. It also serves as the agent's affidavit under AS 13.26.625(b): absent fraud, it is conclusive proof of nonrevocation or nontermination, and when authenticated for record it is recordable if the instrument being exercised under is recordable.

I, ________________________________ (name of agent), certify under penalty of perjury, to my actual knowledge, that:

(1) ________________________________ (name of principal) granted me authority as an agent (or successor agent) in a statutory form power of attorney dated ____________________;

(2) the power of attorney is in full force; I have no actual knowledge that the principal has revoked it or my authority, or that it has terminated under AS 13.26.620;

(3) the principal is alive;

(4) the action I am taking is within the scope of the authority granted in the power of attorney;

(5) if more than one agent is named, the power of attorney provides that the agents act separately / jointly (circle one), or, if it does not provide, the agents act jointly by default (AS 13.26.660(1));

(6) if I act as a successor or alternate agent, each prior agent is unable or unwilling to serve or continue to serve;

(7) the power of attorney became effective upon the incapacity of the principal, that incapacity HAS been established by the affidavit required by AS 13.26.680, and the completed affidavit is attached;

(8) I had, at the time of doing any act under the power of attorney, no actual knowledge of the revocation or termination of the power of attorney by death or incapacity (AS 13.26.625(b)).

Dated: ____________________ at ________________________________, Alaska.

________________________________

(Signature of Agent)(Date)

Agent's printed name: ________________________________

Agent's address: ________________________________

Agent's telephone: ________________________________

Subscribed and sworn to or affirmed before me at ________________________________ on ____________________ by ________________________________ (name of person making statement).

________________________________

(Signature of officer or notary)

Title or rank: ____________________ Serial number, if any: ____________________

My commission expires: ____________________ [Seal]

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Important Information About This Document

THIS PAGE IS NOT PART OF THE STATUTORY FORM. DO NOT RECORD IT. KEEP IT WITH YOUR RECORDS.

What this document is. This is the Alaska statutory form power of attorney (AS 13.26.645) for property and financial matters. You choose the categories of authority to grant in Section 3 and any optional specific authorities in Section 4; unmarked items are NOT granted. This version is SPRINGING: it takes effect only when your incapacity is established by the sworn affidavit in Exhibit A (AS 13.26.680).

How to sign. Sign before a notary public or other officer authorized to take acknowledgments (AS 13.26.600). Witnesses are not required and none are provided. If you are physically unable to sign, another person — who is NOT named as your agent — may sign for you at your direction and in your conscious presence, using the directed-signer block. Remote online notarization is available in Alaska (AS 44.50.075).

Health care is separate. This document does not authorize health-care decisions. Use an Alaska Advance Health Care Directive (AS 13.52) for health care.

If you receive public home care services. A public home care provider paid with state funds may not serve as your agent unless appointed jointly with another person who is not a provider (AS 13.26.630; AS 47.05.017(c)).

Multiple agents. If you name more than one agent and mark neither election, Alaska law requires them to act jointly (AS 13.26.660(1)). One agent, with one or two named alternates, is usually simpler.

How long it lasts. Unless you fill in a term limit, this document continues until you revoke it (AS 13.26.660(4)). You may revoke it while you have capacity — by completing a subsequent power of attorney, or a special power of attorney revoking a specific power. Deliver the revocation to your agent and to anyone relying on the document; if the power of attorney was recorded, record the revocation too.

Recording. Recording is optional for most purposes; for a real-estate transaction, record with the recording district where the land lies (AS 40.17). Page 1 of the form provides the 2-inch blank top margin Alaska recorders require (11 AAC 06.040).

Acceptance by banks and others. A third party may ask your agent for a certification under penalty of perjury (Exhibit B), an English translation, or — for a stated reason — an opinion of counsel (AS 13.26.615). A third party may not require a different form of power of attorney for authority granted in this one, and a person that improperly refuses an acknowledged power of attorney can be ordered by a court to accept it and to pay attorney fees and costs (AS 13.26.615(f)).

Gifts. If you mark the gift power in Section 4, gifts are limited by AS 13.26.665(q): generally up to the annual federal gift-tax exclusion per recipient (twice that amount if your spouse consents to split gifts), consistent with your known objectives or best interest.

Special categories. Category (C) includes stock in Alaska Native Claims Settlement Act corporations (AS 13.26.665(c)). Under category (F), your agent generally may not name the agent as an insurance beneficiary unless the agent is your spouse, child, grandchild, parent, brother, or sister (AS 13.26.665(f)). Category (J) lets your agent act as your personal representative under HIPAA only for payment-related matters — it is not a health-care power of attorney (AS 13.26.665(j)(15)).

Digital assets. The electronic-communications line in Section 4 is the express grant Alaska law requires before your agent may access the CONTENT of your electronic communications (18 U.S.C. 2510(12); AS 13.63). Other digital-asset access follows the defaults of AS 13.63.

Your agent's duties. Your agent accepts the appointment by acting under it (AS 13.26.605) and must act in your best interest, in good faith, within the granted authority, and keep records (AS 13.26.610). An agent who violates these duties must restore your property and may owe attorney fees and costs (AS 13.26.605(b)). An agent may resign by giving you notice and, if you are incapacitated, to your conservator or guardian, co-agent or successor, caregiver, or a protective agency (AS 13.26.620).

Divorce does not revoke. Alaska law does not automatically end a spouse-agent's authority on divorce or separation. If you name your spouse and later want that authority to end, revoke it in writing.

If a court gets involved. Interested persons — including you, your agent, family members, and protective agencies — may ask a court to review your agent's conduct (AS 13.26.635).

Questions. If anything in this document is unclear, ask an Alaska lawyer before you sign. The Alaska Bar Association operates a lawyer referral service, and Alaska Legal Services Corporation assists qualifying Alaskans.