District of Columbia Statutory Power of Attorney

This power of attorney authorizes the person named below as my agent to sell, lease,

grant, encumber, release, or otherwise convey an interest in my real property and to

execute deeds and other instruments for me. I give my agent this power for (initial one):

All my real property.

Only the specific property described as follows:

________________________________________________

DISTRICT OF COLUMBIA

STATUTORY POWER OF ATTORNEY FORM

D.C. Code § 21-2603.01

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 of 2022 (D.C. Official Code § 21-2601.01 et seq.).

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 may be 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 coagent in the Special Instructions. Coagents 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 any 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 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 of 2022 (D.C. Official Code §

21-2601.01 et seq.).

INITIAL each subject you want to include. You may initial All Preceding Subjects instead

of each subject.

Real Property (refer to § 21-2603.03 for additional notice requirements)

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 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 § 21-2602.17 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

Disclaim or refuse an interest in property, including a power of appointment

LIMITATION ON AGENT'S AUTHORITY

An agent that is not my ancestor, spouse or descendant 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 of my estate or guardian of my

person, I nominate the following person(s) for appointment:

Name of Nominee for conservator of my estate:

____________________________________________________

Nominee's Address: ____________________________________________________

Nominee's Telephone Number: ____________________________________________________

Name of Nominee for guardian of my person:

____________________________________________________

Nominee's Address: ____________________________________________________

Nominee's Telephone Number: ____________________________________________________

RELIANCE ON THIS POWER OF ATTORNEY

Any person, including my agent, may rely upon the validity of this power of attorney or a copy of

it unless that person knows it has been terminated or is invalid.

SIGNATURE AND ACKNOWLEDGMENT

Your Signature: ________________________________________________

Date: ________________________________________________

Your Name Printed: ________________________________________________

Your Address: ________________________________________________

Your Telephone Number: ________________________________________________

District of Columbia: ________________________________________________

This document was acknowledged before me on

Date: ________________________________

Name of Principal: ___________________________________________

Signature of Notary: ___________________________________________

My commission expires: ________________________________________

This document was 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 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

(4) 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.

Unless the Special Instructions state otherwise, you must also act loyally, avoid conflicts, act

with care, keep records, cooperate with the principal's health care decision maker, and attempt

to preserve the principal's estate plan when consistent with the principal's best interest.

Termination of Agent's Authority

You must stop acting if you learn that the principal died, revoked the power or your authority, a

stated termination event occurred, the purpose was accomplished, or another event under

District law terminated your authority.

Liability of Agent

The meaning of the authority granted to you is defined in the Uniform Power of Attorney Act of

2022. If you violate the Act or act outside the authority granted, you may be liable for damages.

If you do not understand this document or your duties, seek legal advice.

AGENT'S CERTIFICATION AS TO THE VALIDITY OF

POWER OF ATTORNEY AND AGENT'S AUTHORITY

D.C. Code § 21-2603.02

District of Columbia: ____________________________________________________

I certify under penalty of perjury that the principal named below granted me authority as an

agent or successor agent in a power of attorney.

Name of Agent: ____________________________________________________

Name of Principal: ____________________________________________________

Date of Power of Attorney: ____________________________________________________

I further certify that to my knowledge:

(1) The Principal is alive and has not revoked the Power of Attorney or my authority to act, and

neither has terminated.

(2) If the Power of Attorney becomes effective upon an event or contingency, the event or

contingency has occurred.

(3) If I was named as a successor agent, the prior agent is no longer able or willing to serve.

(4) Other relevant statements:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

SIGNATURE AND ACKNOWLEDGMENT

Agent's Signature: ______________________________________________

Date: ______________________________________________

Agent's Name Printed: ______________________________________________

Agent's Address: ______________________________________________

Agent's Telephone Number: ______________________________________________

This document was acknowledged before me on

Date: ________________________________

Name of Agent: ______________________________________________

Signature of Notary: ___________________________________________

My commission expires: ________________________________________

This document was prepared by: __________________________________