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

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

PACKET GUIDE — REMOVE THIS GUIDE BEFORE SIGNING OR RECORDING. THIS GUIDE IS NOT PART OF THE LEGAL INSTRUMENT. THE INSTRUMENT BEGINS ON THE PAGE TITLED "NEW JERSEY DURABLE POWER OF ATTORNEY."

New Jersey General Durable Power of Attorney for Property & Finances — Packet Guide

This packet contains a New Jersey general durable power of attorney that becomes effective only upon a written certification that you are under a disability (springing), an Important Information for the Agent page, an Agent's Affidavit of Non-Revocation your agent may use when dealing with banks and others (with a spare copy), an Agent's Certification form for digital-asset requests, a Determination of Disability certification slip with a standalone HIPAA authorization, and an optional recording cover page.

(New Jersey Revised Durable Power of Attorney Act, P.L. 2000, c.109 (N.J.S.A. 46:2B-8.1 to -8.14))

What this document is

This is a durable power of attorney for property and finances drafted for New Jersey under the Revised Durable Power of Attorney Act (N.J.S.A. 46:2B-8.1 to 46:2B-8.14) and the banking-acceptance act (N.J.S.A. 46:2B-10 to 46:2B-19). New Jersey does not publish an official statutory form — this is a PublicLegal-drafted instrument built directly on those statutes. "Durable" means your agent's authority continues even if you later become disabled or incapacitated (N.J.S.A. 46:2B-8.2). It covers property and finances only — it does not authorize health-care decisions (New Jersey health-care directives use a separate instrument under the Advance Directives for Health Care Act, N.J.S.A. 26:2H-53 et seq.).

Which version you purchased

Upon Disability (springing). This power of attorney becomes effective only upon a written certification that you are under a disability. New Jersey's default definition — "unable to manage your property and affairs effectively" (N.J.S.A. 46:2B-8.2(c)) — applies only "unless otherwise defined in the instrument," so this instrument defines the mechanism itself: a written certification signed by one licensed physician who has examined you (or, if you complete the optional block, by the certifier you designate). The block also authorizes the certifier to obtain the health information needed to make the certification (HIPAA). The Determination of Disability slip at the end of this packet is the certification form. Note for banks: when a power is effective upon disability, a New Jersey banking institution may require "proof to its satisfaction" that you are then under a disability (N.J.S.A. 46:2B-13(c)) — the completed certification slip is designed to be that proof.

How to sign (the execution ceremony)

Sign and date the instrument in the presence of a notary public (or another officer authorized to take acknowledgments — in New Jersey that includes an attorney-at-law, a county clerk or deputy, a register of deeds or deputy, or a surrogate or deputy surrogate — R.S. 46:14-6.1), who will complete the acknowledgment certificate. New Jersey requires a power of attorney to be in writing, duly signed, and acknowledged (N.J.S.A. 46:2B-8.9; R.S. 46:14-2.1). NO witnesses are required — New Jersey's law never calls for them. You must have capacity when you sign — including for the springing version: a bank must refuse a power of attorney if it has actual notice that the principal was under a disability when it was executed (N.J.S.A. 46:2B-13(a)). Sign in ink; initial the election lines in ink. Sign ONE original — if you execute more than one original, revoking by destruction requires destroying ALL of them (N.J.S.A. 46:2B-8.10); make certified copies instead. New Jersey authorizes remote online notarization (P.L. 2021, c.179; N.J.S.A. 52:7-10.10); if you use it, follow your New Jersey remote notary's process — this instrument is designed for wet-ink signing. If you sign outside New Jersey, any officer authorized by that jurisdiction's law may take the acknowledgment, but an out-of-state notary should apply a seal, and an officer who is not a justice, judge, or notary must state his or her authority in or with the certificate (R.S. 46:14-6.1(b)).

What your agent can do — and what requires your initials

The GRANT OF GENERAL AUTHORITY and ENUMERATED POWERS give your agent the broad powers New Jersey law allows — everything an adult can delegate with respect to property and finances. The banking power uses the exact statutory phrase ("conduct banking transactions as set forth in section 2 of P.L.1991, c.95 (C.46:2B-11)") because a New Jersey banking institution is then REQUIRED by statute to accept and rely on the power, subject only to limited exceptions (N.J.S.A. 46:2B-13), and is protected when it relies in good faith (N.J.S.A. 46:2B-14).

Certain sensitive powers require your express, specific authorization — initialing matters:

• GIFTS. New Jersey forbids gratuitous transfers by an agent "except to the extent that the power of attorney expressly and specifically so authorizes," and declares that general all-acts language is NOT enough (N.J.S.A. 46:2B-8.13a). This instrument therefore grants no gift power unless you initial the gift line — and grants no power to make gifts to the agent personally unless you initial the separate sub-line. The election caps per-donee gifts at the federal gift-tax annual exclusion; if you want to permit larger gifts, or any broader gift program, consult an attorney — that requires custom drafting beyond this form.

• CONTENT OF ELECTRONIC COMMUNICATIONS. Under New Jersey's Uniform Fiduciary Access to Digital Assets Act (N.J.S.A. 3B:14-61.1 to 3B:14-61.18), your agent can reach a catalogue of your electronic communications and your other digital assets with general authority (N.J.S.A. 3B:14-61.10), but the CONTENT of your electronic communications requires an express grant (N.J.S.A. 3B:14-61.9). Initial the content line only if you want that. A direction you give through a provider's own online tool overrides this document (N.J.S.A. 3B:14-61.4).

• COMPENSATION. If you initial the compensation line, your agent is entitled to reasonable compensation; if you do not, compensation is available only as a court may award on application (N.J.S.A. 46:2B-8.12). Reasonable expense reimbursement applies either way.

Naming your agent — and successors, co-agents

Name one attorney-in-fact, plus optional successors who act successively — each successor acts only upon the death, written resignation, or disability of the predecessor (N.J.S.A. 46:2B-8.7(e)). If you name two agents to serve at the same time in the Special Instructions, New Jersey law makes them act JOINTLY unless your instrument expressly says they may act severally (N.J.S.A. 46:2B-8.7(b), (d)) — say which you intend. Your agent may not delegate powers to others unless your instrument specifically provides (N.J.S.A. 46:2B-8.8) — use the Special Instructions if you want to permit delegation.

If a court later appoints a guardian or conservator

A guardian's or conservator's appointment does NOT terminate this power of attorney: your agent becomes accountable to the court-appointed fiduciary as well as to you (N.J.S.A. 46:2B-8.4(a)), and the power continues until a court orders otherwise. The NOMINATION clause lets you nominate the person you want the court to consider as your conservator or guardian (N.J.S.A. 46:2B-8.4(b)). No one OTHER THAN YOU may revoke this power of attorney except a court, for good cause (N.J.S.A. 46:2B-8.4(c)); you keep your own right to revoke at any time while you have capacity (N.J.S.A. 46:2B-8.10). Guardianship proceedings are in the Superior Court, Chancery Division, Probate Part (N.J.S.A. 3B:12-1 et seq.; Court Rule 4:86).

If the agent will deal with real estate: recording

This power of attorney is valid without recording, but a power of attorney used to convey or release any interest in New Jersey real estate should be recorded — before or with the deed — with the county recording officer (the county clerk, or the register of deeds and mortgages in counties that have one) of the county where the land lies (N.J.S.A. 46:26A-2(b)). Recording practice expects each signer's name typed or printed beneath the signature (N.J.S.A. 46:26A-3) and a cover sheet or electronic synopsis (N.J.S.A. 46:26A-5); the optional recording cover page at the end of this packet collects that information — attach it only if you record. The Agent's Affidavit of Non-Revocation is recordable together with recordable instruments (N.J.S.A. 46:2B-8.6). Recording fees are set by the county. Two transaction notes: when your agent conveys realty, the deed closing will still require the seller's Affidavit of Consideration (RTF-1) and, for a nonresident seller, a GIT/REP form (N.J.S.A. 46:15-6) — that is closing practice, not part of this packet; and if you are married and the property is held as a tenancy by the entirety, New Jersey bars one spouse from alienating it without the OTHER spouse's written consent (N.J.S.A. 46:3-17.4) — your agent cannot supply your spouse's consent.

Banks and others may rely on this document

Any third party may rely on this power of attorney until it receives actual notice of revocation, termination, or your death (N.J.S.A. 46:2B-8.6(a)). A third party may require your agent to sign the included Affidavit of Non-Revocation, which is CONCLUSIVE PROOF that the power has not been revoked or terminated (N.J.S.A. 46:2B-8.6(b)). Separately, an act your agent takes in good faith without actual knowledge of your death or incapacity is presumed valid, challengeable only by a clear showing of fraud or gross neglect (N.J.S.A. 46:2B-8.5). Third parties generally may retain and rely on a photocopy or certified copy (N.J.S.A. 46:2B-8.11).

Banking institutions play by a stricter protocol: the bank must first view a power of attorney bearing your ACTUAL ORIGINAL signature — or, if the original is unavailable, a photocopy certified as true by another banking institution or by the county recording office where it was recorded, together with your agent's affidavit that the original is unavailable (N.J.S.A. 46:2B-13(f)). A bank may also require evidence of your agent's identity and a signature card for withdrawals (N.J.S.A. 46:2B-13(d)), may refuse a power first presented more than 10 years after its date unless your agent is your spouse, parent, or a descendant of your parent (N.J.S.A. 46:2B-13(b)), and — for the Upon-Disability version — may require proof to its satisfaction that you are then under a disability, which the included certification slip is designed to supply (N.J.S.A. 46:2B-13(c)). If a bank rejects the power after being given your agent's address in writing, it must notify your agent in writing with the reason (N.J.S.A. 46:2B-13(e)).

Revoking or changing this document

You may revoke this power of attorney at any time while you have capacity, in any of three ways: (1) physically destroy ALL executed originals; (2) sign a written revocation acknowledged before a notary or other authorized officer; or (3) deliver a written revocation to your agent (N.J.S.A. 46:2B-8.10). Signing a NEW power of attorney does NOT revoke this one unless the new document expressly says so (id.) — this instrument contains that express revocation sentence. If this power was recorded, record the revocation in the same county. Always notify your agent and everyone relying on the document.

When this power ends — and what it does not replace

This power of attorney terminates on your death: from then on, only the personal representative of your estate may act (acts an agent completes in good faith without actual knowledge of your death remain valid — N.J.S.A. 46:2B-8.5(a)). This document also does not replace the specialized forms some agencies require: the IRS honors only its own Form 2848 (or 8821) for representation before it; the Social Security Administration does not honor state powers of attorney — a representative payee must be appointed through the SSA; and the New Jersey Motor Vehicle Commission often wants its own power-of-attorney form for vehicle title work. Health-care decisions require an advance directive under N.J.S.A. 26:2H-53 et seq., not this document.

Sources: Revised Durable Power of Attorney Act, N.J.S.A. 46:2B-8.1 to 46:2B-8.14 (P.L. 2000, c.109); N.J.S.A. 46:2B-8.13a (P.L. 2003, c.138, gifts); banking article, N.J.S.A. 46:2B-10 to 46:2B-19 (P.L. 1991, c.95, amended 1994, c.142); R.S. 46:14-2.1 and 46:14-6.1 (acknowledgments); N.J.S.A. 52:7-10.1 et seq. (remote notarization, P.L. 2021, c.179); Uniform Fiduciary Access to Digital Assets Act, N.J.S.A. 3B:14-61.1 to 3B:14-61.18 (P.L. 2017, c.237); N.J.S.A. 3B:12-1 et seq. (guardianship); N.J.S.A. 46:26A-1 et seq. (recording); N.J.S.A. 46:3-17.4 (tenancy by the entirety); N.J.S.A. 46:15-6 (realty transfer fee); N.J.S.A. 26:2H-53 et seq. (health care, not included). Official text: New Jersey Legislature, pub.njleg.gov.

---

NEW JERSEY DURABLE POWER OF ATTORNEY

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

NOTICE TO THE PRINCIPAL

The powers you grant in this document are broad and sweeping. They are governed by the Revised Durable Power of Attorney Act, N.J.S.A. 46:2B-8.1 to 46:2B-8.14, and related New Jersey law. This document does NOT authorize anyone to make medical or other health-care decisions for you — New Jersey health-care directives use a separate instrument (N.J.S.A. 26:2H-53 et seq.). You may revoke this power of attorney at any time while you have capacity. Your agent is a fiduciary who must act solely for your benefit. If you have any questions about these powers, obtain competent legal advice before you sign.

1. DESIGNATION OF ATTORNEY-IN-FACT

I, the Principal named below, appoint the following person as my Attorney-in-Fact (agent) to act for me as provided in this power of attorney:

_____________________________________________________

Name of Attorney-in-Fact

_____________________________________________________

Address of Attorney-in-Fact (street, city, state, ZIP)

Telephone of Attorney-in-Fact: _________________________

Optional successors. If my Attorney-in-Fact dies, resigns in writing, or becomes disabled, I appoint the following person(s) as successor Attorney(s)-in-Fact, to act successively in the order named (N.J.S.A. 46:2B-8.7(e)):

_____________________________________________________

Name of first successor Attorney-in-Fact (optional)

_____________________________________________________

Address of first successor (street, city, state, ZIP)

_____________________________________________________

Name of second successor Attorney-in-Fact (optional)

_____________________________________________________

Address of second successor (street, city, state, ZIP)

Co-agents. If I name more than one person to serve at the same time in the Special Instructions, New Jersey law requires them to act JOINTLY unless this document expressly provides that they may act severally (N.J.S.A. 46:2B-8.7(b), (d)). To permit co-agents to act severally, state so in the Special Instructions.

2. DURABILITY

THIS POWER OF ATTORNEY SHALL BECOME EFFECTIVE UPON THE DISABILITY OR INCAPACITY OF THE PRINCIPAL

The statement above is the durability language prescribed by N.J.S.A. 46:2B-8.2(b).

3. EFFECTIVE DATE

This power of attorney becomes effective ONLY upon a written certification that I am under a disability, as provided below. Until that certification, my Attorney-in-Fact has no authority under this power of attorney.

Definition and manner of certification (prescribed by this instrument as permitted by N.J.S.A. 46:2B-8.2(c)): I am "under a disability" when I am unable to manage my property and affairs effectively. That fact shall be established by a written certification, signed and dated, in which the signer certifies that he or she has examined me and determined that I am unable to manage my property and affairs effectively. The certification shall be made by:

(a) the certifier I have designated below, if I have designated one and that person is able and willing to act — the designated certifier's written certification controls; or

(b) otherwise, any physician licensed to practice medicine who has examined me.

Optional certifier designation:

_____________________________________________________

Name of person designated to make the certification (optional)

Address and telephone of designated certifier: ______________________________________

I authorize any certifier named or identified above, and any physician making the certification, to act as my personal representative under HIPAA solely to the extent necessary or convenient to obtain the health information needed to make the certification described above.

My Attorney-in-Fact shall obtain the dated, signed written certification before exercising any authority under this power of attorney, and a copy of the certification shall be retained with this power of attorney. The Determination of Disability slip included with this power of attorney may be used for that certification. A New Jersey banking institution may require proof to its satisfaction that I am then under a disability (N.J.S.A. 46:2B-13(c)); the completed certification is intended to be that proof. The Agent's Affidavit of Non-Revocation may also be used to confirm the happening of the contingency (N.J.S.A. 46:2B-8.6).

Once effective, this power of attorney remains effective in accordance with the durability statement above, even during later intervals when I am able to manage my property and affairs effectively, unless I provide otherwise in the Special Instructions.

4. GRANT OF GENERAL AUTHORITY

I grant my Attorney-in-Fact GENERAL POWERS to act in a fiduciary capacity on my behalf with respect to ALL LAWFUL SUBJECTS AND PURPOSES concerning my property and finances, except as limited or conditioned in this power of attorney. This grant includes every act I could perform through an agent if personally present and capable of acting; my Attorney-in-Fact shall have no greater authority or rights than I could exercise on my own behalf (N.J.S.A. 46:2B-15). This grant does NOT include the powers listed in Section 6, which are granted ONLY where I have expressly and specifically authorized them by initialing, and does NOT authorize my Attorney-in-Fact to make, alter, or revoke a will for me, to make health-care decisions for me, or to act after my death (this power of attorney terminates on my death).

5. ENUMERATED POWERS

Without limiting the general grant, my Attorney-in-Fact may:

A. Real property — buy, sell, exchange, lease, mortgage, encumber, manage, improve, insure, and convey any interest in real property; execute and deliver deeds, mortgages, leases, easements, closing documents, and affidavits of title; and record any instrument. (If I am married and property is held as a tenancy by the entirety, New Jersey bars one spouse from alienating it without the written consent of BOTH spouses — N.J.S.A. 46:3-17.4; my Attorney-in-Fact cannot supply the other spouse's consent.)

B. Tangible personal property — buy, sell, lease, store, ship, insure, and otherwise deal with tangible personal property, including vehicles and watercraft, and execute titles and registrations.

C. Banking — conduct banking transactions as set forth in section 2 of P.L.1991, c.95 (C.46:2B-11). New Jersey banking institutions are required by N.J.S.A. 46:2B-13 to accept and rely on this power of attorney with respect to banking transactions, subject to that statute's limited exceptions, and are protected when they rely in good faith (N.J.S.A. 46:2B-14). Among other things, this authority includes continuing, modifying, or terminating accounts; opening accounts; hiring, accessing, removing the contents of, and surrendering safe-deposit boxes; drawing, signing, and delivering checks and drafts; withdrawing funds by check, order, draft, wire, or electronic transfer; using lines of credit connected with accounts; applying for and using automatic-teller-machine and debit cards (including my existing cards); applying for and using a bank credit card issued in the Attorney-in-Fact's name as an alternate user — but NOT using my existing bank credit card accounts (C.46:2B-11(c)); borrowing and securing loans; and demanding and receiving money and property from any banking institution.

D. Business operations — operate, manage, reorganize, or terminate any business interest; exercise rights under entity documents; vote ownership interests; and deal with partnerships, limited liability companies, and corporations.

E. Insurance and annuities — purchase, maintain, surrender, borrow against, and deal with insurance policies and annuity contracts (but not change a beneficiary designation except as initialed in Section 6, if so provided).

F. Estates, trusts, and inheritances — receive, disclaim (if initialed in Section 6), transfer, and otherwise deal with any interest in an estate, trust, escrow, or inheritance, and represent me in Surrogate's Court and Probate Part proceedings.

G. Claims and litigation — institute, prosecute, defend, settle, arbitrate, and compromise claims; collect debts; and execute releases.

H. Personal and family maintenance — pay for the support, maintenance, education, and accustomed standard of living of me and those I am legally obligated to support.

I. Government benefits — apply for, receive, and manage Social Security, Medicare, Medicaid, veterans', and other government benefits, and appeal adverse determinations.

J. Retirement plans — deal with pension, profit-sharing, IRA, and other retirement plans and accounts, including elections, rollovers, and distributions (but not change a beneficiary designation except as initialed in Section 6, if so provided).

K. Taxes — prepare, sign, and file federal, state, and local tax returns and information filings; represent me before the IRS and the New Jersey Division of Taxation; pay taxes; and receive refunds.

L. Digital assets — access, manage, control, archive, and delete my digital assets (electronic records, accounts, files, and stored data) and obtain a catalogue of my electronic communications, as an agent with general authority may under N.J.S.A. 3B:14-61.10 (access to the CONTENT of electronic communications requires the express election in Section 6).

M. All other lawful acts — to do any other lawful act concerning my property and finances that I could do through an agent if personally present and capable of acting, and to employ and compensate attorneys, accountants, brokers, and other assistants. This catch-all does NOT authorize gifts of my property (N.J.S.A. 46:2B-8.13a) or any other power listed in Section 6, which is granted only if initialed.

6. EXPRESS ELECTIONS — INITIAL EACH POWER YOU GRANT

New Jersey grants the following powers ONLY where the power of attorney expressly and specifically authorizes them. INITIAL each line you grant. A line you do not initial is NOT granted.

(___) Gifts to others — I expressly and specifically authorize my Attorney-in-Fact to make gifts of my property to other persons, in trust or otherwise (N.J.S.A. 46:2B-8.13a), in amounts per donee per year not exceeding the federal gift-tax annual exclusion (Internal Revenue Code § 2503(b)), exercising the fiduciary duty to act solely for my benefit (N.J.S.A. 46:2B-8.13(a)).

_____ If (and ONLY if) this second line is also initialed, the gift power includes gifts to my Attorney-in-Fact personally. Leave blank to forbid gifts to my Attorney-in-Fact.

(___) CONTENT of electronic communications — I EXPRESSLY GRANT my Attorney-in-Fact authority over the content of my electronic communications, as N.J.S.A. 3B:14-61.9 requires for content. (A direction I give through a provider's online tool overrides this document — N.J.S.A. 3B:14-61.4.)

(___) Beneficiary designations and survivorship — to create or change beneficiary designations and survivorship interests in my property. (This modifies my estate plan; initial only if intended.)

(___) Disclaimers — to disclaim or renounce, in whole or in part, any gift, devise, inheritance, or other interest in property to which I may become entitled (N.J.S.A. 3B:9-1 et seq.).

(___) REASONABLE COMPENSATION — my Attorney-in-Fact shall be entitled to reasonable compensation for services performed as my agent, in addition to reimbursement of reasonable expenses. (Without this initial, compensation is available only as a court may award on application — N.J.S.A. 46:2B-8.12.) [OPTIONAL ELECTION — leave blank to keep the New Jersey-law default]

Withholding. Unless I have initialed the matching line above (or stated otherwise in the Special Instructions), my Attorney-in-Fact shall NOT: make gifts of my property (N.J.S.A. 46:2B-8.13a); change beneficiary designations or survivorship interests; disclaim or renounce property; access the content of my electronic communications (N.J.S.A. 3B:14-61.9); create, amend, or revoke a trust; or sell or transfer my property to himself or herself (N.J.S.A. 46:2B-8.13(a)).

7. SPECIAL INSTRUCTIONS

(Optional — for example: limits on particular powers, a direction that co-agents may act severally (see Section 1), permission for my agent to delegate (N.J.S.A. 46:2B-8.8), a statement that an earlier power of attorney remains in effect despite Section 9, or other directions. Attach additional signed pages if needed.)

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

8. NOMINATION OF GUARDIAN OR CONSERVATOR (OPTIONAL)

If protective proceedings for my person or estate are commenced, I nominate the following person for the court's consideration as my conservator, guardian of my estate, or guardian of my person (N.J.S.A. 46:2B-8.4(b)):

_____________________________________________________

Name of nominee (optional)

_____________________________________________________

Address and telephone of nominee

9. REVOCATION, GOVERNING LAW, AND RELIANCE

I revoke every earlier general power of attorney for property or financial matters that I have signed (never any health-care directive). (Signing a later power of attorney would not revoke this one unless it expressly said so — N.J.S.A. 46:2B-8.10; this sentence keeps earlier general powers from surviving alongside this document. If you want an earlier power to remain in effect, say so in the Special Instructions.)

This power of attorney is executed under and governed by the Revised Durable Power of Attorney Act, N.J.S.A. 46:2B-8.1 to 46:2B-8.14, and, with respect to banking transactions, P.L. 1991, c.95 (N.J.S.A. 46:2B-10 to 46:2B-19). Any third party may rely on this power of attorney until the third party receives actual notice of its revocation, of the termination or suspension of my Attorney-in-Fact's authority, or of my death, and may require my Attorney-in-Fact to execute an affidavit of non-revocation, which is conclusive proof that this power has not been revoked or terminated (N.J.S.A. 46:2B-8.6); a photocopy or certified copy of this document may be retained and relied upon (N.J.S.A. 46:2B-8.11).

My Attorney-in-Fact is a fiduciary who must act within the powers granted and solely for my benefit, must maintain accurate books and records, and may be required to account (N.J.S.A. 46:2B-8.13; N.J.S.A. 46:2B-19). If a court appoints a conservator or guardian for me, my Attorney-in-Fact becomes accountable to that fiduciary as well (N.J.S.A. 46:2B-8.4(a)). This power of attorney terminates on my death.

---

10. EXECUTION AND ACKNOWLEDGMENT

I sign my name to this Durable Power of Attorney on the date below, and I acknowledge it in the manner set forth in R.S. 46:14-2.1 (N.J.S.A. 46:2B-8.9).

_____________________________________________________

Signature of Principal

_____________________________________________________

Printed name of Principal

_____________________________________________________

Date signed (month, day, year)

_____________________________________________________

Address of Principal (street, city, state, ZIP)

CERTIFICATE OF ACKNOWLEDGMENT

(Notary public or other authorized officer — New Jersey form, R.S. 46:14-2.1 and R.S. 46:14-6.1)

State of New Jersey

County of _______________________ ss.:

I certify that on _______________________, 20_____, the following person personally came before me:

_______________________________________________________

(name of Principal)

and acknowledged under oath, to my satisfaction, that this person (or if more than one, each person):

(a) is named in and personally signed the attached document; and

(b) signed, sealed and delivered the attached document as this person's act and deed.

_____________________________________________________

Signature of officer taking the acknowledgment

_____________________________________________________

Printed name and title (Notary Public / Attorney at Law of New Jersey / other R.S. 46:14-6.1 officer)

My commission expires (notaries): ________________________

(A seal is not required of a New Jersey officer — R.S. 46:14-2.1(d); an out-of-state notary should apply one as a practical matter. An officer who is not a justice, judge, or notary must state his or her authority — R.S. 46:14-6.1(b).)

---

IMPORTANT INFORMATION FOR THE AGENT

A summary for the Attorney-in-Fact — keep with the power of attorney. (N.J.S.A. 46:2B-8.1 et seq.; N.J.S.A. 46:2B-10 et seq.)

If you act under this power of attorney, New Jersey law makes you a fiduciary. In summary:

• You must act within the powers the power of attorney delegates and SOLELY for the benefit of the Principal (N.J.S.A. 46:2B-8.13(a)). You are a fiduciary within the meaning of the Uniform Fiduciaries Law (N.J.S.A. 46:2B-19; N.J.S.A. 3B:14-52 et seq.).

• You must maintain accurate books and records of ALL financial transactions. The Principal, a court-appointed guardian or conservator, and the personal representative of the Principal's estate may require you to render an accounting — and the Superior Court may order one on the application of any heir or next friend if the Principal is incapacitated and there is doubt or concern about your conduct (N.J.S.A. 46:2B-8.13(b)).

• You may NOT make gifts of the Principal's property — to yourself or to anyone else — except to the extent the power of attorney expressly and specifically authorizes gifts. General "all acts" language is not enough (N.J.S.A. 46:2B-8.13a). Check Section 6 of the instrument for the Principal's initials before making any gift.

• You may NOT delegate your powers to others unless the power of attorney specifically provides for delegation; if it does, you must still exercise reasonable care, skill, and caution (N.J.S.A. 46:2B-8.8).

• You have no greater authority or rights than the Principal could exercise personally (N.J.S.A. 46:2B-15). You may never make, alter, or revoke a will for the Principal, and you may not act after the Principal's death (the power terminates at death).

• If a court appoints a conservator or guardian of the Principal's estate, you become accountable to that fiduciary as well as to the Principal (N.J.S.A. 46:2B-8.4(a)).

• Third parties may rely on the power of attorney until they receive actual notice of revocation, termination of your authority, or the Principal's death; they may ask you to sign the Affidavit of Non-Revocation included with this packet, which is conclusive proof that the power remains in effect (N.J.S.A. 46:2B-8.6). Acts you take in good faith without actual knowledge of the Principal's death, revocation, or incapacity are presumed valid (N.J.S.A. 46:2B-8.5).

• Banking institutions are required to accept and rely on this power of attorney for banking transactions, subject to limited statutory exceptions (N.J.S.A. 46:2B-13): they may view the ORIGINAL signed document or a certified copy, may require evidence of your identity and a signature card for withdrawals, and may refuse a power first presented more than 10 years after its date unless you are the Principal's spouse, parent, or a descendant of a parent. If the power is effective upon the Principal's disability, the institution may require proof to its satisfaction that the Principal is then under a disability — the completed Determination of Disability slip serves that purpose.

• If the Principal granted you authority over digital assets: handle them under the same fiduciary duties; you may not use them to impersonate the Principal; access to the CONTENT of electronic communications exists only if expressly granted in Section 6 (N.J.S.A. 3B:14-61.9, 3B:14-61.10, 3B:14-61.15).

• You are entitled to compensation only as the power of attorney or a separate written agreement provides; otherwise a court may award reasonable compensation on application (N.J.S.A. 46:2B-8.12).

OPTIONAL — AGENT'S ACKNOWLEDGMENT AND ACCEPTANCE

New Jersey law does not require the agent to sign an acknowledgment, but signing below confirms that you have read this page and accept the duties it summarizes.

_____________________________________________________

Signature of Attorney-in-Fact (optional)

_____________________________________________________

Printed name

Date: ______________________________

---

AGENT'S AFFIDAVIT OF NON-REVOCATION

For use when a third party requests confirmation — under N.J.S.A. 46:2B-8.6(b) this affidavit is CONCLUSIVE PROOF that the power of attorney has not been revoked or terminated; recordable with recordable instruments. (The separate presumption of N.J.S.A. 46:2B-8.5(c) protects particular acts and is challengeable only by a clear showing of fraud or gross neglect.)

State of New Jersey

County of _______________________ ss.:

I, the undersigned Attorney-in-Fact (or successor Attorney-in-Fact) named in the attached Durable Power of Attorney, being duly sworn, depose and state:

1. The attached Durable Power of Attorney was executed by the Principal, is genuine, and is in full force and effect. At the time I acted or now act under it, I did not have and do not have actual knowledge of the termination of the power of attorney by revocation, of the termination or suspension of my authority as Attorney-in-Fact, or of the Principal's death, disability, or incapacity (except, if the power is effective upon disability, the certified disability described in paragraph 3) (N.J.S.A. 46:2B-8.6(b)).

2. The Principal is alive. To the best of my knowledge and belief, the Principal had legal capacity when the power of attorney was executed.

3. [Complete if the power of attorney is effective upon the Principal's disability or incapacity, or if a successor's authority has vested:] The event or events making the power of attorney effective, or vesting authority in a successor Attorney-in-Fact, have occurred, as follows (attach the written certification of disability, if any):

______________________________________________________________________________

______________________________________________________________________________

4. I am the person designated as Attorney-in-Fact (or successor Attorney-in-Fact) in the power of attorney and am qualified and authorized to act under it (N.J.S.A. 46:2B-8.7). I certify under penalty of perjury that the power of attorney is in effect (N.J.S.A. 3B:14-61.9(c), 3B:14-61.10(c)).

_____________________________________________________

Signature of Attorney-in-Fact (or successor)

_____________________________________________________

Printed name

Date: ______________________________

Capacity (Attorney-in-Fact / successor): ________________________

JURAT

(Notary public or other authorized officer — R.S. 46:14-2.1, R.S. 46:14-6.1)

Sworn to and subscribed before me on _______________________, 20_____, by

____________________________________________________________

(name of Attorney-in-Fact signing this affidavit)

who is personally known to me or who provided satisfactory evidence of identity.

____________________________________________

Signature of officer (seal — not required of a New Jersey officer, R.S. 46:14-2.1(d); out-of-state notaries should apply one)

_____________________________________________________

Printed name and title

My commission expires (notaries): ________________________

---

AGENT'S AFFIDAVIT OF NON-REVOCATION

SPARE COPY — use the first copy before this one

State of New Jersey

County of _______________________ ss.:

I, the undersigned Attorney-in-Fact (or successor Attorney-in-Fact) named in the attached Durable Power of Attorney, being duly sworn, depose and state:

1. The attached Durable Power of Attorney was executed by the Principal, is genuine, and is in full force and effect. At the time I acted or now act under it, I did not have and do not have actual knowledge of the termination of the power of attorney by revocation, of the termination or suspension of my authority as Attorney-in-Fact, or of the Principal's death, disability, or incapacity (except, if the power is effective upon disability, the certified disability described in paragraph 3) (N.J.S.A. 46:2B-8.6(b)).

2. The Principal is alive. To the best of my knowledge and belief, the Principal had legal capacity when the power of attorney was executed.

3. [Complete if the power of attorney is effective upon the Principal's disability or incapacity, or if a successor's authority has vested:] The event or events making the power of attorney effective, or vesting authority in a successor Attorney-in-Fact, have occurred, as follows (attach the written certification of disability, if any):

______________________________________________________________________________

______________________________________________________________________________

4. I am the person designated as Attorney-in-Fact (or successor Attorney-in-Fact) in the power of attorney and am qualified and authorized to act under it (N.J.S.A. 46:2B-8.7). I certify under penalty of perjury that the power of attorney is in effect (N.J.S.A. 3B:14-61.9(c), 3B:14-61.10(c)).

_____________________________________________________

Signature of Attorney-in-Fact (or successor)

_____________________________________________________

Printed name

Date: ______________________________

Capacity (Attorney-in-Fact / successor): ________________________

JURAT

(Notary public or other authorized officer — R.S. 46:14-2.1, R.S. 46:14-6.1)

Sworn to and subscribed before me on _______________________, 20_____, by

____________________________________________________________

(name of Attorney-in-Fact signing this affidavit)

who is personally known to me or who provided satisfactory evidence of identity.

____________________________________________

Signature of officer (seal — not required of a New Jersey officer, R.S. 46:14-2.1(d); out-of-state notaries should apply one)

_____________________________________________________

Printed name and title

My commission expires (notaries): ________________________

---

AGENT'S CERTIFICATION FOR DIGITAL-ASSET REQUESTS

Packet addition — present to a custodian (Google, Apple, Meta, banks' online portals, etc.) together with the power of attorney when requesting access to the Principal's digital assets. New Jersey's Uniform Fiduciary Access to Digital Assets Act entitles the custodian to this certification under penalty of perjury (N.J.S.A. 3B:14-61.9(c) and 3B:14-61.10(c)); the custodian generally must comply within 60 days of a complete request (N.J.S.A. 3B:14-61.16).

I, the undersigned Attorney-in-Fact (or successor Attorney-in-Fact) named in the attached Durable Power of Attorney, certify under penalty of perjury that:

1. The attached power of attorney is in full force and effect; it has not been revoked, terminated, or suspended, and I have no actual knowledge of the Principal's death or of any event terminating or suspending it or my authority.

2. I am the person designated as Attorney-in-Fact (or successor) in the power of attorney and am qualified and authorized to act under it.

3. This certification accompanies a written request for disclosure directed to (custodian): ____________________________________

4. The request concerns (check one): ☐ a catalogue of electronic communications and digital assets other than content (N.J.S.A. 3B:14-61.10) ☐ the content of electronic communications — granted expressly in Section 6 of the power of attorney (N.J.S.A. 3B:14-61.9).

5. If requested by the custodian, the following identifies the Principal's account or links the account to the Principal:

______________________________________________________________________________

_____________________________________________________

Signature of Attorney-in-Fact (or successor)

_____________________________________________________

Printed name

Date: ______________________________

Address and telephone: __________________________________________

---

DETERMINATION OF DISABILITY — PHYSICIAN'S WRITTEN CERTIFICATION

PACKET ADDITION for the "Effective Upon Disability" power of attorney — a New Jersey banking institution may require proof to its satisfaction that the Principal is under a disability (N.J.S.A. 46:2B-13(c)); this certification is the proof the instrument prescribes.

This certification concerns the Durable Power of Attorney executed by:

_____________________________________________________

Name of Principal

Date of the power of attorney: ________________________________

_____________________________________________________

Name of Attorney-in-Fact presenting this certification

CERTIFICATION

I, the undersigned physician, certify that:

1. I am a physician licensed to practice medicine in _______________________________________.

2. I examined the Principal named above on _______________________________ (month, day, year).

3. In my professional judgment, as a result of that examination, the Principal is unable to manage his or her property and affairs effectively — that is, the Principal is under a disability within the meaning of the power of attorney described above and N.J.S.A. 46:2B-8.2.

4. The Principal has authorized the disclosure of the health information necessary to make this certification (HIPAA authorization in the power of attorney).

_____________________________________________________

Signature of physician

_____________________________________________________

Printed name of physician

License number and state: ______________________________

Date signed: ______________________________

_____________________________________________________

Address and telephone of physician

---

AUTHORIZATION TO DISCLOSE HEALTH INFORMATION (HIPAA)

PACKET ADDITION for the "Effective Upon Disability" power of attorney — a standalone authorization (45 C.F.R. § 164.508) so the physician or other certifier may disclose to your agent the health information needed to make the written certification of disability the power of attorney requires.

1. Patient / Principal:

_____________________________________________________

Name of Principal (patient)

Date of birth: ______________________________

2. I authorize the following to make the disclosure: ANY physician, psychologist, or other health-care provider who has examined or treated me — including the certifier designated in my Durable Power of Attorney.

3. Disclosure may be made TO: the Attorney(s)-in-Fact named in my Durable Power of Attorney:

_____________________________________________________

Name(s) of Attorney(s)-in-Fact authorized to receive the information

4. Information to be disclosed: information sufficient to determine whether I am unable to manage my property and affairs effectively — including cognitive, functional, and diagnostic findings bearing on that determination — and no more.

5. Purpose: to make the written certification of disability required for my Durable Power of Attorney to become effective.

6. Expiration: this authorization expires when the certification described in paragraph 5 has been made, or when I revoke it, whichever is earlier. I may revoke this authorization in writing at any time, except to the extent a provider has already relied on it.

7. I understand that information disclosed under this authorization may be re-disclosed by the recipient and may no longer be protected by federal privacy rules, and that my treatment may not be conditioned on my signing this authorization.

_____________________________________________________

Signature of Principal (patient)

_____________________________________________________

Printed name of Principal

Date signed: ______________________________

If signed by a personal representative, describe the representative's authority: __________________________________________

OPTIONAL RECORDING COVER PAGE — ATTACH AS THE FIRST PAGE ONLY IF YOU RECORD THIS POWER OF ATTORNEY WITH THE COUNTY RECORDING OFFICER. THIS PAGE IS NOT PART OF THE LEGAL INSTRUMENT.

Recording Cover Page — New Jersey Durable Power of Attorney

Title of document: New Jersey Durable Power of Attorney

_____________________________________________________

Date of document (date the power of attorney was signed)

_____________________________________________________

Grantor — Principal's full name

_____________________________________________________

Grantor's mailing address (street, city, state, ZIP)

_____________________________________________________

Grantee — Attorney-in-Fact's full name

_____________________________________________________

Grantee's mailing address (street, city, state, ZIP)

Municipality(ies) and county(ies) where the affected real property is located (if recorded for a real-estate transaction):

______________________________________________________________________________

After recording, return to:

_____________________________________________________

Name and address for return of the recorded document

Record with the County Clerk — or the Register of Deeds and Mortgages, in counties that have one — of the county where the land lies. The Agent's Affidavit of Non-Revocation may be recorded together with recordable instruments (N.J.S.A. 46:2B-8.6). The county recording officer sets reproduction and margin standards; do not write in the top margin. Names should be printed beneath signatures on the instrument.