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HB6477 Enrolled |
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LRB096 21113 AJO 36964 b |
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| AN ACT concerning civil law.
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| Be it enacted by the People of the State of Illinois, |
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| represented in the General Assembly:
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| Section 5. The Illinois Power of Attorney Act is amended by |
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| changing Sections 2-1, 2-3, 2-5, 2-7, 2-8, 2-10, 2-11, 3-3, |
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| 3-4, 4-4, 4-10, and 4-12 and by adding Sections 2-10.3, 2-10.5, |
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| 2-10.6, 3-3.6, 3-5, and 4-5.1 as follows:
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| (755 ILCS 45/2-1) (from Ch. 110 1/2, par. 802-1)
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| Sec. 2-1. Purpose. The General Assembly recognizes that |
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| each
individual has the right to appoint an agent to make deal |
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| with property , financial, or make
personal , and health care |
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| decisions for the individual but that this right
cannot be |
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| fully effective unless the principal may empower the agent to |
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| act
throughout the principal's lifetime, including during |
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| periods of
disability, and have confidence be sure that third |
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| parties will honor the agent's authority
at all times.
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| The General Assembly finds that in the light of modern |
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| financial needs
and advances in medical science, the statutory |
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| recognition of this right of
delegation in Illinois needs to be |
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| restated , which will to , among other things, expand the
its |
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| application and the permissible scope of the agent's authority, |
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| clarify
the power of the individual to authorize an agent to |
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| make financial and
care decisions for the individual and better |
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LRB096 21113 AJO 36964 b |
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| protect health care personnel
and other third parties who rely |
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| in good faith on the agent so that
reliance will be assured. |
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| Nothing in this Act shall be deemed to
authorize or encourage |
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| euthanasia, suicide or any action or course of
action that |
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| violates the criminal law of this State or the United States.
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| Similarly, nothing in this Act shall be deemed to authorize or |
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| encourage
any violation of a civil right expressed in the |
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| Constitution, statutes,
case law and administrative rulings of |
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| this State (including, without
limitation, the right of |
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| conscience respected and protected by the Health
Care Right of |
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| Conscience Act, as now or hereafter amended) or the
United |
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| States or any action or course of action that violates the |
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| public policy
expressed in the Constitution, statutes, case law |
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| and administrative rulings of
this State or the United States.
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| (Source: P.A. 90-655, eff. 7-30-98.)
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| (755 ILCS 45/2-3) (from Ch. 110 1/2, par. 802-3)
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| Sec. 2-3. Definitions. As used in this Act:
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| (a) "Agency" means the written power of attorney or other |
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| instrument of
agency governing the relationship between the |
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| principal and agent or the
relationship, itself, as appropriate |
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| to the context, and includes agencies
dealing with personal or |
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| health care as well as property. An agency is
subject to this |
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| Act to the extent it may be controlled by the principal,
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| excluding agencies and powers for the benefit of the agent.
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| (b) "Agent" means the attorney-in-fact or other person |
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| designated to act
for the principal in the agency.
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| (c) "Disabled person" has the same meaning as in the |
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| "Probate Act of
1975", as now or hereafter amended. To be under |
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| a "disability" or
"disabled" means to be a disabled person.
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| (c-5) "Incapacitated", when used to describe a principal, |
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| means that the principal is under a legal disability as defined |
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| in Section 11a-2 of the Probate Act of 1975. A principal shall |
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| also be considered incapacitated if: (i) a physician licensed |
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| to practice medicine in all of its branches has examined the |
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| principal and has determined that the principal lacks decision |
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| making capacity; (ii) that physician has made a written record |
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| of this determination and has signed the written record within |
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| 90 days after the examination; and (iii) the written record has |
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| been delivered to the agent. The agent may rely conclusively on |
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| the written record. |
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| (d) "Person" means an individual, corporation, trust, |
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| partnership or
other entity, as appropriate to the agency.
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| (e) "Principal" means an individual (including, without |
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| limitation, an
individual acting as trustee, representative or |
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| other fiduciary) who signs
a power of attorney or other |
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| instrument of agency granting powers to an agent.
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| (Source: P.A. 85-701.)
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| (755 ILCS 45/2-5) (from Ch. 110 1/2, par. 802-5)
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| Sec. 2-5. Duration of agency - amendment and revocation. |
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| Unless the
agency states an earlier termination date, the |
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| agency continues until the
death of the principal, |
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| notwithstanding any lapse of time, the principal's
disability |
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| or incapacity or appointment of a guardian for the principal
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| after the agency is signed. Every agency may be amended or |
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| revoked by the
principal , if the principal has the capacity to |
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| do so, at any time and in any manner communicated to the agent |
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| or to any
other person related to the subject matter of the |
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| agency, except that
revocation and amendment of health care |
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| agencies are governed by Section 4-6
of this Act except to the |
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| extent the terms of the agencies are inconsistent
with that |
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| Section. The execution of a power of attorney does not revoke a |
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| power of attorney previously executed by the principal unless |
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| the subsequent power of attorney provides that the previous |
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| power of attorney is revoked or that all other powers of |
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| attorney are revoked.
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| (Source: P.A. 86-736.)
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| (755 ILCS 45/2-7) (from Ch. 110 1/2, par. 802-7)
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| Sec. 2-7. Duty - standard of care - record-keeping - |
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| exoneration. |
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| (a) The agent shall be under
no duty to exercise the powers |
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| granted by the agency or to assume control
of or responsibility |
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| for any of the principal's property, care or affairs,
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| regardless of the principal's physical or mental condition. |
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| Whenever a
power is exercised, the agent shall use due care to |
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| act in good faith for the benefit of
the principal using due |
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| care, competence, and diligence in accordance with the terms of |
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| the agency and shall be
liable for negligent exercise. An agent |
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| who acts with due care for the
benefit of the principal shall |
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| not be liable or limited merely because the
agent also benefits |
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| from the act, has individual or conflicting interests
in |
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| relation to the property, care or affairs of the principal or |
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| acts in a
different manner with respect to the agency and the |
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| agent's individual
interests. The agent shall keep a record of |
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| all receipts, disbursements,
and significant actions taken |
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| under the agency.
The agent shall not be
affected by any |
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| amendment or termination
of the agency until the agent has |
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| actual knowledge thereof. The agent
shall not be liable for any |
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| loss due to error of judgment nor for the act
or default of any |
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| other person.
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| (b) An agent that has accepted appointment must act in |
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| accordance with the principal's expectations to the extent |
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| actually known to the agent and otherwise in the principal's |
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| best interests. |
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| (c) An agent shall keep a record of all receipts, |
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| disbursements, and significant actions taken under the |
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| authority of the agency and shall provide a copy of this record |
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| when requested to do so by: |
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| (1) the principal, a guardian, another fiduciary |
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| acting on behalf of the principal, and, after the death of |
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| the principal, the personal representative or successors |
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| in interest of the principal's estate; |
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LRB096 21113 AJO 36964 b |
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| (2) a representative of a provider agency, as defined |
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| in Section 2 of the Elder Abuse and Neglect Act, acting in |
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| the course of an assessment of a complaint of elder abuse |
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| or neglect under that Act; |
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| (3) a representative of the Office of the State Long |
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| Term Care Ombudsman, acting in the course of an |
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| investigation of a complaint of financial exploitation of a |
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| nursing home resident under Section 4.04 of the Illinois |
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| Act on the Aging; |
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| (4) a representative of the Office of Inspector General |
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| for the Department of Human Services, acting in the course |
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| of an assessment of a complaint of financial exploitation |
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| of an adult with disabilities pursuant to Section 35 of the |
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| Abuse of Adults with Disabilities Intervention Act; or |
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| (5) a court under Section 2-10 of this Act. |
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| (d) If the agent fails to provide his or her record of all |
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| receipts, disbursements, and significant actions within 21 |
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| days after a request under subsection (c), the elder abuse |
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| provider agency or the State Long Term Care Ombudsman may |
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| petition the court for an order requiring the agent to produce |
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| his or her record of receipts, disbursements, and significant |
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| actions. If the court finds that the agent's failure to provide |
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| his or her record in a timely manner to the elder abuse |
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| provider agency or the State Long Term Care Ombudsman was |
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| without good cause, the court may assess reasonable costs and |
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| attorney's fees against the agent, and order such other relief |
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LRB096 21113 AJO 36964 b |
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| as is appropriate. |
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| (e) An agent is not required to disclose receipts, |
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| disbursements, or other significant actions conducted on |
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| behalf of the principal except as otherwise provided in the |
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| power of attorney or as required under subsection (c). |
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| (f) An agent that violates this Act is liable to the |
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| principal or the principal's successors in interest for the |
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| amount required (i) to restore the value of the principal's |
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| property to what it would have been had the violation not |
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| occurred, and (ii) to reimburse the principal or the |
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| principal's successors in interest for the attorney's fees and |
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| costs paid on the agent's behalf. This subsection does not |
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| limit any other applicable legal or equitable remedies. |
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| (Source: P.A. 86-736.)
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| (755 ILCS 45/2-8) (from Ch. 110 1/2, par. 802-8)
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| Sec. 2-8. Reliance on
document purporting to establish an
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| agency. |
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| (a) Any person who acts in good faith
reliance on a copy of
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| a document purporting to establish an agency will be fully |
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| protected and
released to
the same extent as though the reliant |
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| had dealt directly with the
named
principal
as a |
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| fully-competent person. The
named
agent shall furnish an |
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| affidavit or Agent's Certification and Acceptance of Authority |
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| to the
reliant on demand stating that the instrument relied on |
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| is a true copy of
the agency and that, to the best of the
named
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HB6477 Enrolled |
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LRB096 21113 AJO 36964 b |
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| agent's knowledge, the named principal is
alive and the |
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| relevant powers of the
named
agent have not been altered or
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| terminated; but good faith reliance on
a document purporting to |
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| establish an agency will protect the reliant
without the |
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| affidavit or Agent's Certification and Acceptance of |
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| Authority . |
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| (b) Upon request, the named agent in a power of attorney |
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| shall furnish an Agent's Certification and Acceptance of |
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| Authority to the reliant in substantially the following form: |
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| AGENT'S CERTIFICATION AND ACCEPTANCE OF AUTHORITY |
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| I, .......... (insert name of agent), certify that the |
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| attached is a true copy of a power of attorney naming the |
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| undersigned as agent or successor agent for ............. |
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| (insert name of principal). |
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| I certify that to the best of my knowledge the principal |
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| had the capacity to execute the power of attorney, is alive, |
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| and has not revoked the power of attorney; that my powers as |
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| agent have not been altered or terminated; and that the power |
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| of attorney remains in full force and effect. |
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| I accept appointment as agent under this power of attorney. |
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| This certification and acceptance is made under penalty of |
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| perjury.* |
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| Dated: ............ |
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| .......................
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LRB096 21113 AJO 36964 b |
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| (Agent's Signature)
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| .......................
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| (Print Agent's Name)
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| .......................
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| (Agent's Address)
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| *(NOTE: Perjury is defined in Section 32-2 of the Criminal |
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| Code of 1961, and is a Class 3 felony.) |
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| (c) Any person dealing with an agent
named in a copy of a |
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| document purporting to establish an agency
may presume, in
the |
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| absence of actual knowledge to the contrary, that the
document |
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| purporting to establish the
agency was
validly executed,
that |
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| the agency was validly established,
that the named principal |
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| was competent at the time
of execution, and that, at the time |
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| of reliance, the
named
principal is alive,
the agency
was |
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| validly established
and has not terminated or been amended, the |
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| relevant powers of the
named
agent were properly and validly |
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| granted and have not terminated or
been amended, and the acts |
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| of the
named
agent conform to the standards of this Act.
No |
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| person relying on
a copy of a document purporting to establish |
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| an agency shall be required to see to the application
of any |
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| property delivered to or controlled by the
named
agent or to |
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| question the
authority of the
named
agent. |
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| (d) Each person to whom a direction by the named agent in
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| accordance with the terms of the
copy of the document |
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| purporting to establish an
agency is communicated shall comply |
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LRB096 21113 AJO 36964 b |
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| with
that direction, and any person who fails to comply |
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| arbitrarily or without
reasonable cause shall be subject to |
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| civil liability for any damages
resulting from noncompliance.
A |
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| health care provider who complies with Section 4-7 shall not be
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| deemed to have acted arbitrarily or without reasonable cause.
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| (Source: P.A. 90-21, eff. 6-20-97.)
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| (755 ILCS 45/2-10) (from Ch. 110 1/2, par. 802-10)
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| Sec. 2-10. Agency-court relationship. |
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| (a) Upon petition by any interested
person (including the |
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| agent), with such notice to interested persons as the
court |
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| directs and a finding by the court that the principal
lacks |
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| either the capacity to control or the capacity to revoke the |
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| agency , the court may construe a power of attorney, review the |
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| agent's conduct, and grant appropriate relief including |
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| compensatory damages. : (a) if |
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| (b) If the court finds
that the agent is not acting for the |
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| benefit of the principal in accordance
with the terms of the |
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| agency or that the agent's action or inaction has
caused or |
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| threatens substantial harm to the principal's person or |
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| property
in a manner not authorized or intended by the |
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| principal, the court may
order a guardian of the principal's |
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| person or estate to exercise any powers
of the principal under |
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| the agency, including the power to revoke the
agency, or may |
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| enter such other orders without appointment of a guardian as
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| the court deems necessary to provide for the best interests of |
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LRB096 21113 AJO 36964 b |
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| the
principal . |
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| (c) If ; or (b) if the court finds that the agency requires
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| interpretation, the court may construe the agency and instruct |
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| the agent,
but the court may not amend the agency. |
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| (d) If the court finds that the agent has not acted for the |
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| benefit of the principal in accordance with the terms of the |
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| agency and the Illinois Power of Attorney Act, or that the |
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| agent's action caused or threatened substantial harm to the |
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| principal's person or property in a manner not authorized or |
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| intended by the principal, then the agent shall not be |
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| authorized to pay or be reimbursed from the estate of the |
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| principal the attorneys' fees and costs of the agent in |
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| defending a proceeding brought pursuant to this Section. |
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| (e) Upon a finding that the agent's action has caused |
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| substantial harm to the principal's person or property, the |
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| court may assess against the agent reasonable costs and |
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| attorney's fees to a prevailing party who is a provider agency |
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| as defined in Section 2 of the Elder Abuse and Neglect Act, a |
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| representative of the Office of the State Long Term Care |
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| Ombudsman, or a governmental agency having regulatory |
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| authority to protect the welfare of the principal. |
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| (f) As used in this Section, the term "interested person" |
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| includes (1) the principal or the agent; (2) a guardian of the |
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| person, guardian of the estate, or other fiduciary charged with |
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| management of the principal's property; (3) the principal's |
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| spouse, parent, or descendant; (4) a person who would be a |
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| presumptive heir-at-law of the principal; (5) a person named as |
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| a beneficiary to receive any property, benefit, or contractual |
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| right upon the principal's death, or as a beneficiary of a |
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| trust created by or for the principal; (6) a provider agency as |
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| defined in Section 2 of the Elder Abuse and Neglect Act, a |
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| representative of the Office of the State Long Term Care |
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| Ombudsman, or a governmental agency having regulatory |
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| authority to protect the welfare of the principal; and (7) the |
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| principal's caregiver or another person who demonstrates |
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| sufficient interest in the principal's welfare. |
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| (g) Absent court order directing a
guardian to exercise |
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| powers of the principal under the agency, a guardian
will have |
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| no power, duty or liability with respect to any property |
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| subject
to the agency or any personal or health care matters |
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| covered by the agency. |
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| (h)
Proceedings under this Section shall be commenced in |
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| the county where the
guardian was appointed or, if no Illinois |
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| guardian is acting, then in the
county where the agent or |
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| principal resides or where the principal owns real property or, |
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| if the agent does not reside in
Illinois, then in any county .
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| (i) This Section shall not be construed to limit any other |
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| remedies available. |
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| (Source: P.A. 85-701.)
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| (755 ILCS 45/2-10.3 new) |
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| Sec. 2-10.3. Successor agents. |
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| (a) A principal may designate one or more successor agents |
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| to act if an initial or predecessor agent resigns, dies, |
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| becomes incapacitated, is not qualified to serve, or declines |
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| to serve. A principal may grant authority to another person, |
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| designated by name, by office, or by function, including an |
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| initial or successor agent, to designate one or more successor |
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| agents. Unless a power of attorney otherwise provides, a |
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| successor agent has the same authority as that granted to an |
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| initial agent. |
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| (b) An agent is not liable for the actions of another |
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| agent, including a predecessor agent, unless the agent |
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| participates in or conceals a breach of fiduciary duty |
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| committed by the other agent. An agent who has knowledge of a |
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| breach or imminent breach of fiduciary duty by another agent |
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| must notify the principal and, if the principal is |
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| incapacitated, take whatever actions may be reasonably |
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| appropriate in the circumstances to safeguard the principal's |
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| best interest. |
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| (c) Any person who acts in good faith reliance on the |
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| representation of a successor agent regarding the |
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| unavailability of a predecessor agent will be fully protected |
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| and released to the same extent as though the reliant had dealt |
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| directly with the predecessor agent. Upon request, the |
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| successor agent shall furnish an affidavit or Successor Agent's |
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| Certification and Acceptance of Authority to the reliant, but |
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| good faith reliance on a document purporting to establish an |
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| agency will protect the reliant without the affidavit or |
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| Successor Agent's Certification and Acceptance of Authority. A |
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| Successor Agent's Certification and Acceptance of Authority |
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| shall be in substantially the following form: |
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| SUCCESSOR AGENT'S |
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| CERTIFICATION AND ACCEPTANCE OF AUTHORITY |
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| I certify that the attached is a true copy of a power of |
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| attorney naming the undersigned as agent or successor agent for |
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| .......... (insert name of principal). |
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| I certify that to the best of my knowledge the principal |
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| had the capacity to execute the power of attorney, is alive, |
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| and has not revoked the power of attorney; that my powers as |
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| agent have not been altered or terminated; and that the power |
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| of attorney remains in full force and effect. |
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| I certify that to the best of my knowledge .......... |
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| (insert name of unavailable agent) is unavailable due to |
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| ................. (specify death, resignation, absence, |
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| illness, or other temporary incapacity). |
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| I accept appointment as agent under this power of attorney. |
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| This certification and acceptance is made under penalty of |
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| perjury.* |
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| Dated: ............ |
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| .......................
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| (Agent's Signature)
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HB6477 Enrolled |
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LRB096 21113 AJO 36964 b |
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| .......................
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| (Print Agent's Name)
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| .......................
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| (Agent's Address)
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| *(NOTE: Perjury is defined in Section 32-2 of the Criminal |
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| Code of 1961, and is a Class 3 felony.) |
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| (755 ILCS 45/2-10.5 new)
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| Sec. 2-10.5. Co-agents. |
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| (a) Co-agents may not be named by a principal in a |
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| statutory short form power of attorney for property under |
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| Article III or a statutory short form power of attorney for |
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| health care under Article IV. In the event that co-agents are |
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| named in any other form of power of attorney, then the |
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| provisions of this Section shall govern the use and acceptance |
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| of co-agency designations. |
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| (b) Unless the power of attorney or this Section otherwise |
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| provides, authority granted to 2 or more co-agents is |
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| exercisable only by their majority consent. However, if prompt |
19 |
| action is required to accomplish the purposes of the power of |
20 |
| attorney or to avoid irreparable injury to the principal's |
21 |
| interests and an agent is unavailable because of absence, |
22 |
| illness, or other temporary incapacity, the other agent or |
23 |
| agents may act for the principal. If a vacancy occurs in one or |
24 |
| more of the designations of agent under a power of attorney, |
25 |
| the remaining agent or agents may act for the principal. |
|
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HB6477 Enrolled |
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LRB096 21113 AJO 36964 b |
|
|
1 |
| (c) An agent is not liable for the actions of another |
2 |
| agent, including a co-agent or predecessor agent, unless the |
3 |
| agent participates in or conceals a breach of fiduciary duty |
4 |
| committed by the other agent. An agent who has knowledge of a |
5 |
| breach or imminent breach of fiduciary duty by another agent |
6 |
| must notify the principal and, if the principal is |
7 |
| incapacitated, take whatever actions may be reasonably |
8 |
| appropriate in the circumstances to safeguard the principal's |
9 |
| best interest. |
10 |
| (d) Any person who acts in good faith reliance on the |
11 |
| representation of a co-agent regarding the unavailability of a |
12 |
| predecessor agent or one or more co-agents, or the need for |
13 |
| prompt action to accomplish the purposes of the power of |
14 |
| attorney or to avoid irreparable injury to the principal's |
15 |
| interests, will be fully protected and released to the same |
16 |
| extent as though the reliant had dealt directly with all named |
17 |
| agents. Upon request, the co-agent shall furnish an affidavit |
18 |
| or Co-Agent's Certification and Acceptance of Authority to the |
19 |
| reliant, but good faith reliance on a document purporting to |
20 |
| establish an agency will protect the reliant without the |
21 |
| affidavit or Co-Agent's Certification and Acceptance of |
22 |
| Authority. A Co-Agent's Certification and Acceptance of |
23 |
| Authority shall be in substantially the following form: |
24 |
| CO-AGENT'S |
25 |
| CERTIFICATION AND ACCEPTANCE OF AUTHORITY |
|
|
|
HB6477 Enrolled |
- 17 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| I certify that the attached is a true copy of a power of |
2 |
| attorney naming the undersigned as agent or co-agent for |
3 |
| .......... (insert name of principal). |
4 |
| I certify that to the best of my knowledge the principal |
5 |
| had the capacity to execute the power of attorney, is alive, |
6 |
| and has not revoked the power of attorney; that my powers as |
7 |
| agent have not been altered or terminated; and that the power |
8 |
| of attorney remains in full force and effect. |
9 |
| I certify that to the best of my knowledge .......... |
10 |
| (insert name of unavailable agent) is unavailable due to |
11 |
| ................. (specify death, resignation, absence, |
12 |
| illness, or other temporary incapacity). |
13 |
| I certify that prompt action is required to accomplish the |
14 |
| purposes of the power of attorney or to avoid irreparable |
15 |
| injury to the principal's interests. |
16 |
| I accept appointment as agent under this power of attorney. |
17 |
| This certification and acceptance is made under penalty of |
18 |
| perjury.* |
19 |
| Dated: ............ |
20 |
| .......................
|
21 |
| (Agent's Signature)
|
22 |
| .......................
|
23 |
| (Print Agent's Name)
|
24 |
| .......................
|
25 |
| (Agent's Address)
|
|
|
|
HB6477 Enrolled |
- 18 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| *(NOTE: Perjury is defined in Section 32-2 of the Criminal |
2 |
| Code of 1961, and is a Class 3 felony.) |
3 |
| (755 ILCS 45/2-10.6 new)
|
4 |
| Sec. 2-10.6. Power of attorney executed in another state or |
5 |
| country; pre-existing powers of attorney. |
6 |
| (a) A power of attorney executed in another state or |
7 |
| country is valid and enforceable in this State if its creation |
8 |
| complied when executed with: |
9 |
| (1) the law of the state or country in which the power |
10 |
| of attorney was executed; |
11 |
| (2) the law of this State; |
12 |
| (3) the law of the state or country where the principal |
13 |
| is domiciled, has a place of abode or business, or is a |
14 |
| national; or |
15 |
| (4) the law of the state or country where the agent is |
16 |
| domiciled or has a place of business. |
17 |
| (b) A power of attorney executed in this State before the |
18 |
| effective date of this amendatory Act of the 96th General |
19 |
| Assembly is valid and enforceable in this State if its creation |
20 |
| complied with the law of this State as it existed at the time |
21 |
| of execution.
|
22 |
| (755 ILCS 45/2-11) (from Ch. 110 1/2, par. 802-11)
|
23 |
| Sec. 2-11. Saving clause. This Act does not in any way
|
24 |
| invalidate any agency executed or any act of any agent done, or
|
|
|
|
HB6477 Enrolled |
- 19 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| affect any claim, right or remedy that accrued, prior to
|
2 |
| September 22, 1987.
|
3 |
| This amendatory Act of the 96th General Assembly does not |
4 |
| in any way invalidate any agency executed or any act of any |
5 |
| agent done, or affect any claim, right, or remedy that accrued |
6 |
| prior to the effective date of this amendatory Act of the 96th |
7 |
| General Assembly. |
8 |
| (Source: P.A. 86-736.)
|
9 |
| (755 ILCS 45/3-3) (from Ch. 110 1/2, par. 803-3)
|
10 |
| Sec. 3-3. Statutory short form power of attorney for |
11 |
| property. |
12 |
| (a) The
following form prescribed in this Section may be |
13 |
| known as "statutory property power" and may be used
to grant an |
14 |
| agent powers with respect to property and financial matters.
|
15 |
| The "statutory property power" consists of the following: (1) |
16 |
| Notice to the Individual Signing the Illinois Statutory Short |
17 |
| Form Power of Attorney for Property; (2) Illinois Statutory |
18 |
| Short Form Power of Attorney for Property; and (3) Notice to |
19 |
| Agent. When a power of attorney in substantially the following |
20 |
| form prescribed in this Section is used,
including all 3 items |
21 |
| above, with item (1), the Notice to Individual Signing the |
22 |
| Illinois Statutory Short Form Power of Attorney for Property, |
23 |
| on a separate sheet (coversheet) in 14-point type the "notice" |
24 |
| paragraph at the beginning in capital letters and
the notarized |
25 |
| form of acknowledgment at the end, it shall have the meaning
|
|
|
|
HB6477 Enrolled |
- 20 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| and effect prescribed in this Act. |
2 |
| (b) A power of attorney shall also be deemed to be in |
3 |
| substantially the same format as the statutory form if the |
4 |
| explanatory language throughout the form (the language |
5 |
| following the designation "NOTE:") is distinguished in some way |
6 |
| from the legal paragraphs in the form, such as the use of |
7 |
| boldface or other difference in typeface and font or point |
8 |
| size, even if the "Notice" paragraphs at the beginning are not |
9 |
| on a separate sheet of paper or are not in 14-point type, or if |
10 |
| the principal's initials do not appear in the acknowledgement |
11 |
| at the end of the "Notice" paragraphs. |
12 |
| The validity of a power of attorney as
meeting the |
13 |
| requirements of a statutory property power shall not be
|
14 |
| affected by the fact that one or more of the categories of |
15 |
| optional powers
listed in the form are struck out or the form |
16 |
| includes specific
limitations on or additions to the agent's |
17 |
| powers, as permitted by the
form. Nothing in this Article shall |
18 |
| invalidate or bar use by the
principal of any other or |
19 |
| different form of power of attorney for property.
Nonstatutory |
20 |
| property powers (i) must be executed by the principal , (ii) |
21 |
| must and
designate the agent and the agent's powers , (iii) must |
22 |
| be signed by at least one witness to the principal's signature, |
23 |
| and (iv) must indicate that the principal has acknowledged his |
24 |
| or her signature before a notary public. However, nonstatutory |
25 |
| property powers , but they need not be acknowledged
or
conform |
26 |
| in any other respect to the statutory property power.
|
|
|
|
HB6477 Enrolled |
- 21 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| (c) The Notice to the Individual Signing the Illinois |
2 |
| Statutory Short Form Power of Attorney for Property shall be |
3 |
| substantially as follows: |
4 |
| "NOTICE TO THE INDIVIDUAL SIGNING THE ILLINOIS |
5 |
| STATUTORY SHORT FORM POWER OF ATTORNEY FOR PROPERTY. |
6 |
| PLEASE READ THIS NOTICE CAREFULLY. The form that you will |
7 |
| be signing is a legal document. It is governed by the Illinois |
8 |
| Power of Attorney Act. If there is anything about this form |
9 |
| that you do not understand, you should ask a lawyer to explain |
10 |
| it to you. |
11 |
| The purpose of this Power of Attorney is to give your |
12 |
| designated "agent" broad powers to handle your financial |
13 |
| affairs, which may include the power to pledge, sell, or |
14 |
| dispose of any of your real or personal property, even without |
15 |
| your consent or any advance notice to you. When using the |
16 |
| Statutory Short Form, you may name successor agents, but you |
17 |
| may not name co-agents. |
18 |
| This form does not impose a duty upon your agent to handle |
19 |
| your financial affairs, so it is important that you select an |
20 |
| agent who will agree to do this for you. It is also important |
21 |
| to select an agent whom you trust, since you are giving that |
22 |
| agent control over your financial assets and property. Any |
23 |
| agent who does act for you has a duty to act in good faith for |
24 |
| your benefit and to use due care, competence, and diligence. He |
|
|
|
HB6477 Enrolled |
- 22 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| or she must also act in accordance with the law and with the |
2 |
| directions in this form. Your agent must keep a record of all |
3 |
| receipts, disbursements, and significant actions taken as your |
4 |
| agent. |
5 |
| Unless you specifically limit the period of time that this |
6 |
| Power of Attorney will be in effect, your agent may exercise |
7 |
| the powers given to him or her throughout your lifetime, both |
8 |
| before and after you become incapacitated. A court, however, |
9 |
| can take away the powers of your agent if it finds that the |
10 |
| agent is not acting properly. You may also revoke this Power of |
11 |
| Attorney if you wish. |
12 |
| This Power
of Attorney does not authorize your agent to |
13 |
| appear in court for you as an attorney-at-law or otherwise to |
14 |
| engage in the practice of law unless he or she is a licensed |
15 |
| attorney who is authorized to practice law in Illinois. |
16 |
| The powers you give your agent are explained more fully in |
17 |
| Section 3-4 of the Illinois Power of Attorney Act. This form is |
18 |
| a part of that law. The "NOTE" paragraphs throughout this form |
19 |
| are instructions. |
20 |
| You are not required to sign this Power of Attorney, but it |
21 |
| will not take effect without your signature. You should not |
22 |
| sign this Power of Attorney if you do not understand everything |
23 |
| in it, and what your agent will be able to do if you do sign it. |
24 |
| Please place your initials on the following line indicating |
25 |
| that you have read this Notice: |
|
|
|
HB6477 Enrolled |
- 23 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| .....................
|
2 |
| Principal's initials"
|
3 |
| (d) The Illinois Statutory Short Form Power of Attorney for |
4 |
| Property shall be substantially as follows: |
5 |
| "ILLINOIS STATUTORY SHORT FORM |
6 |
| POWER OF ATTORNEY FOR PROPERTY
|
7 |
| (NOTICE: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE |
8 |
| THE PERSON YOU
DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE |
9 |
| YOUR PROPERTY, WHICH MAY
INCLUDE POWERS TO PLEDGE, SELL OR |
10 |
| OTHERWISE DISPOSE OF ANY REAL OR PERSONAL
PROPERTY WITHOUT |
11 |
| ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THIS FORM DOES
NOT |
12 |
| IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS; BUT |
13 |
| WHEN POWERS
ARE EXERCISED, YOUR AGENT WILL HAVE TO USE DUE CARE |
14 |
| TO ACT FOR YOUR
BENEFIT AND IN ACCORDANCE WITH THIS FORM AND |
15 |
| KEEP A RECORD OF RECEIPTS,
DISBURSEMENTS AND SIGNIFICANT |
16 |
| ACTIONS TAKEN AS AGENT. A COURT CAN TAKE AWAY THE POWERS
OF |
17 |
| YOUR AGENT IF IT FINDS THE AGENT IS NOT ACTING PROPERLY. YOU |
18 |
| MAY NAME
SUCCESSOR AGENTS UNDER THIS FORM BUT NOT CO-AGENTS. |
19 |
| UNLESS YOU EXPRESSLY
LIMIT THE DURATION OF THIS POWER IN THE |
20 |
| MANNER PROVIDED BELOW, UNTIL YOU
REVOKE THIS POWER OR A COURT |
21 |
| ACTING ON YOUR BEHALF TERMINATES IT, YOUR
AGENT MAY EXERCISE |
22 |
| THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN
AFTER YOU |
23 |
| BECOME DISABLED. THE POWERS YOU GIVE YOUR AGENT ARE EXPLAINED
|
|
|
|
HB6477 Enrolled |
- 24 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| MORE FULLY IN SECTION 3-4 OF THE ILLINOIS "STATUTORY SHORT FORM |
2 |
| POWER OF
ATTORNEY FOR PROPERTY LAW" OF WHICH THIS FORM IS A |
3 |
| PART
(SEE THE BACK OF THIS FORM). THAT LAW EXPRESSLY PERMITS |
4 |
| THE USE OF ANY
DIFFERENT FORM OF POWER OF ATTORNEY YOU MAY |
5 |
| DESIRE. IF THERE IS ANYTHING
ABOUT THIS FORM THAT YOU DO NOT |
6 |
| UNDERSTAND, YOU SHOULD ASK A LAWYER TO EXPLAIN
IT TO YOU.)
|
7 |
| POWER OF ATTORNEY made this .... day of ....... (month) |
8 |
| ...... (year)
|
9 |
| 1. I, ..............., (insert name and address of |
10 |
| principal)
hereby revoke all prior powers of attorney for |
11 |
| property executed by me and appoint:
|
12 |
| .............................................................
|
13 |
| (insert name and address of agent)
|
14 |
| (NOTE: You may not name co-agents using this form.) |
15 |
| as my attorney-in-fact (my "agent") to act for me and in my |
16 |
| name (in any
way I could act in person) with respect to the |
17 |
| following powers, as defined
in Section 3-4 of the "Statutory |
18 |
| Short Form Power of Attorney for Property Law"
(including all |
19 |
| amendments), but subject to any limitations on or additions
to |
20 |
| the specified powers inserted in paragraph 2 or 3 below:
|
21 |
| (NOTE: You must strike out any one or more of the following |
22 |
| categories of
powers you do not want your agent to have. |
23 |
| Failure to strike the title
of any category will cause the |
24 |
| powers described in that category to be
granted to the agent. |
25 |
| To strike out a category you must draw a line
through the title |
|
|
|
HB6477 Enrolled |
- 25 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| of that category.) (YOU MUST STRIKE OUT ANY ONE OR MORE OF THE |
2 |
| FOLLOWING CATEGORIES OF
POWERS YOU DO NOT WANT YOUR AGENT TO |
3 |
| HAVE. FAILURE TO STRIKE THE TITLE
OF ANY CATEGORY WILL CAUSE |
4 |
| THE POWERS DESCRIBED IN THAT CATEGORY TO BE
GRANTED TO THE |
5 |
| AGENT. TO STRIKE OUT A CATEGORY YOU MUST DRAW A LINE
THROUGH |
6 |
| THE TITLE OF THAT CATEGORY.)
|
7 |
| (a) Real estate transactions.
|
8 |
| (b) Financial institution transactions.
|
9 |
| (c) Stock and bond transactions.
|
10 |
| (d) Tangible personal property transactions.
|
11 |
| (e) Safe deposit box transactions.
|
12 |
| (f) Insurance and annuity transactions.
|
13 |
| (g) Retirement plan transactions.
|
14 |
| (h) Social Security, employment and military service |
15 |
| benefits.
|
16 |
| (i) Tax matters.
|
17 |
| (j) Claims and litigation.
|
18 |
| (k) Commodity and option transactions.
|
19 |
| (l) Business operations.
|
20 |
| (m) Borrowing transactions.
|
21 |
| (n) Estate transactions.
|
22 |
| (o) All other property powers and transactions.
|
23 |
| (NOTE: Limitations on and additions to the agent's powers may |
24 |
| be included in this power of attorney if they are specifically |
25 |
| described below.) (LIMITATIONS ON AND ADDITIONS TO THE AGENT'S |
26 |
| POWERS MAY BE INCLUDED IN THIS
POWER OF ATTORNEY IF THEY ARE |
|
|
|
HB6477 Enrolled |
- 26 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| SPECIFICALLY DESCRIBED BELOW.)
|
2 |
| 2. The powers granted above shall not include the following |
3 |
| powers or
shall be modified or limited in the following |
4 |
| particulars : |
5 |
| ( NOTE: Here here you may
include any specific limitations you |
6 |
| deem appropriate, such as a
prohibition or conditions on the |
7 |
| sale of particular stock or real estate or
special rules on |
8 |
| borrowing by the agent . ) :
|
9 |
| .............................................................
|
10 |
| .............................................................
|
11 |
| .............................................................
|
12 |
| .............................................................
|
13 |
| .............................................................
|
14 |
| 3. In addition to the powers granted above, I grant my |
15 |
| agent the
following powers : |
16 |
| ( NOTE: Here here you may add any other delegable powers |
17 |
| including,
without limitation, power to make gifts, exercise |
18 |
| powers of appointment,
name or change beneficiaries or joint |
19 |
| tenants or revoke or amend any trust
specifically referred to |
20 |
| below . ) :
|
21 |
| .............................................................
|
22 |
| .............................................................
|
23 |
| .............................................................
|
24 |
| .............................................................
|
25 |
| .............................................................
|
26 |
| (NOTE: Your agent will have authority to employ other persons |
|
|
|
HB6477 Enrolled |
- 27 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| as necessary to enable the agent to properly exercise the |
2 |
| powers granted in this form, but your agent will have to make |
3 |
| all discretionary decisions. If you want to give your agent the |
4 |
| right to delegate discretionary decision-making powers to |
5 |
| others, you should keep paragraph 4, otherwise it should be |
6 |
| struck out.) (YOUR AGENT WILL HAVE AUTHORITY TO EMPLOY OTHER |
7 |
| PERSONS AS NECESSARY TO
ENABLE THE AGENT TO PROPERLY EXERCISE |
8 |
| THE POWERS GRANTED IN THIS FORM, BUT
YOUR AGENT WILL HAVE TO |
9 |
| MAKE ALL DISCRETIONARY DECISIONS. IF YOU WANT TO
GIVE YOUR |
10 |
| AGENT THE RIGHT TO DELEGATE DISCRETIONARY DECISION-MAKING |
11 |
| POWERS
TO OTHERS, YOU SHOULD KEEP THE NEXT SENTENCE, OTHERWISE |
12 |
| IT SHOULD BE STRUCK OUT.)
|
13 |
| 4. My agent shall have the right by written instrument to |
14 |
| delegate any
or all of the foregoing powers involving |
15 |
| discretionary decision-making to
any person or persons whom my |
16 |
| agent may select, but such delegation may be
amended or revoked |
17 |
| by any agent (including any successor) named by me who
is |
18 |
| acting under this power of attorney at the time of reference.
|
19 |
| (NOTE: Your agent will be entitled to reimbursement for all |
20 |
| reasonable expenses incurred in acting under this power of |
21 |
| attorney. Strike out paragraph 5 if you do not want your agent |
22 |
| to also be entitled to reasonable compensation for services as |
23 |
| agent.) (YOUR AGENT WILL BE ENTITLED TO REIMBURSEMENT FOR ALL |
24 |
| REASONABLE EXPENSES
INCURRED IN ACTING UNDER THIS POWER OF |
25 |
| ATTORNEY. STRIKE OUT THE NEXT
SENTENCE IF YOU DO NOT WANT YOUR |
26 |
| AGENT TO ALSO BE ENTITLED TO REASONABLE
COMPENSATION FOR |
|
|
|
HB6477 Enrolled |
- 28 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| SERVICES AS AGENT.)
|
2 |
| 5. My agent shall be entitled to reasonable compensation |
3 |
| for services
rendered as agent under this power of attorney.
|
4 |
| (NOTE: This power of attorney may be amended or revoked by you |
5 |
| at any time and in any manner. Absent amendment or revocation, |
6 |
| the authority granted in this power of attorney will become |
7 |
| effective at the time this power is signed and will continue |
8 |
| until your death, unless a limitation on the beginning date or |
9 |
| duration is made by initialing and completing one or both of |
10 |
| paragraphs 6 and 7:) (THIS POWER OF ATTORNEY MAY BE AMENDED OR |
11 |
| REVOKED BY YOU AT ANY TIME AND IN
ANY MANNER. ABSENT AMENDMENT |
12 |
| OR REVOCATION, THE AUTHORITY GRANTED IN THIS
POWER OF ATTORNEY |
13 |
| WILL BECOME EFFECTIVE AT THE TIME THIS POWER IS SIGNED
AND WILL |
14 |
| CONTINUE UNTIL YOUR DEATH UNLESS A LIMITATION ON THE BEGINNING
|
15 |
| DATE OR DURATION IS MADE BY INITIALING AND COMPLETING EITHER |
16 |
| (OR BOTH) OF
THE FOLLOWING:)
|
17 |
| 6. ( ) This power of attorney shall become effective on
|
18 |
| .............................................................
|
19 |
| ( NOTE: Insert insert a future date or event during your |
20 |
| lifetime, such as a court
determination of your disability or a |
21 |
| written determination by your physician that you are |
22 |
| incapacitated , when you want this power to first take effect . )
|
23 |
| 7. ( ) This power of attorney shall terminate on
|
24 |
| .............................................................
|
25 |
| ( NOTE: Insert insert a future date or event, such as a court |
26 |
| determination that you are not under a legal disability or a |
|
|
|
HB6477 Enrolled |
- 29 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| written determination by your physician that you are not |
2 |
| incapacitated, if of your
disability, when you want this power |
3 |
| to terminate prior to your death . )
|
4 |
| (NOTE: If you wish to name one or more successor agents, insert |
5 |
| the name and address of each successor agent in paragraph 8.) |
6 |
| (IF YOU WISH TO NAME SUCCESSOR AGENTS, INSERT THE NAME(S) AND |
7 |
| ADDRESS(ES)
OF SUCH SUCCESSOR(S) IN THE FOLLOWING PARAGRAPH.)
|
8 |
| 8. If any agent named by me shall die, become incompetent, |
9 |
| resign
or refuse to accept the office of agent, I name the |
10 |
| following
(each to act alone and successively,
in the order |
11 |
| named) as successor(s) to such agent:
|
12 |
| .............................................................
|
13 |
| .............................................................
|
14 |
| For purposes of this paragraph 8, a person shall be considered |
15 |
| to be
incompetent if and while the person is a minor or an |
16 |
| adjudicated
incompetent or disabled person or the person is |
17 |
| unable to give prompt and
intelligent consideration to business |
18 |
| matters, as certified by a licensed physician.
|
19 |
| (NOTE: If you wish to, you may name your agent as guardian of |
20 |
| your estate if a court decides that one should be appointed. To |
21 |
| do this, retain paragraph 9, and the court will appoint your |
22 |
| agent if the court finds that this appointment will serve your |
23 |
| best interests and welfare. Strike out paragraph 9 if you do |
24 |
| not want your agent to act as guardian.) (IF YOU WISH TO NAME |
25 |
| YOUR AGENT AS
GUARDIAN OF YOUR ESTATE, IN THE EVENT A COURT |
26 |
| DECIDES THAT ONE
SHOULD BE APPOINTED, YOU
MAY, BUT ARE NOT |
|
|
|
HB6477 Enrolled |
- 30 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| REQUIRED TO, DO SO BY RETAINING THE FOLLOWING PARAGRAPH.
THE |
2 |
| COURT
WILL APPOINT YOUR AGENT IF THE COURT FINDS THAT SUCH |
3 |
| APPOINTMENT WILL SERVE YOUR
BEST INTERESTS AND WELFARE. STRIKE |
4 |
| OUT PARAGRAPH 9 IF YOU DO NOT WANT
YOUR AGENT TO ACT AS |
5 |
| GUARDIAN.)
|
6 |
| 9. If a guardian of my estate (my property) is to be |
7 |
| appointed, I
nominate the agent acting under this power of |
8 |
| attorney as such guardian,
to serve without bond or security.
|
9 |
| 10. I am fully informed as to all the contents of this form |
10 |
| and
understand the full import of this grant of powers to my |
11 |
| agent.
|
12 |
| (NOTE: This form does not authorize your agent to appear in |
13 |
| court for you as an attorney-at-law or otherwise to engage in |
14 |
| the practice of law unless he or she is a licensed attorney who |
15 |
| is authorized to practice law in Illinois.) |
16 |
| 11. The Notice to Agent is incorporated by reference and |
17 |
| included as part of this form. |
18 |
| Dated: ................ |
19 |
| Signed ..........................................
|
20 |
| (principal)
|
21 |
| (YOU MAY, BUT ARE NOT REQUIRED TO, REQUEST YOUR AGENT AND |
22 |
| SUCCESSOR
AGENTS TO PROVIDE SPECIMEN SIGNATURES BELOW. IF YOU |
23 |
| INCLUDE SPECIMEN
SIGNATURES IN THIS POWER OF ATTORNEY, YOU MUST |
24 |
| COMPLETE THE CERTIFICATION
OPPOSITE THE SIGNATURES OF THE |
25 |
| AGENTS.)
|
26 |
| Specimen signatures of I certify that the signatures
|
|
|
|
HB6477 Enrolled |
- 31 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| agent (and successors) of my agent (and successors)
|
2 |
| are correct.
|
3 |
| .......................... .............................
|
4 |
| (agent) (principal)
|
5 |
| .......................... .............................
|
6 |
| (successor agent) (principal)
|
7 |
| .......................... .............................
|
8 |
| (successor agent) (principal)
|
9 |
| (NOTE: This power of attorney will not be effective unless it |
10 |
| is signed by at least one witness and your signature is |
11 |
| notarized, using the form below. The notary may not also sign |
12 |
| as a witness.) (THIS POWER OF ATTORNEY WILL NOT BE EFFECTIVE |
13 |
| UNLESS IT IS NOTARIZED AND
SIGNED BY AT LEAST ONE ADDITIONAL |
14 |
| WITNESS,
USING THE FORM BELOW.)
|
15 |
| The undersigned witness certifies that ..............., known |
16 |
| to me to be
the same person whose name is subscribed as |
17 |
| principal to the foregoing power of
attorney, appeared before |
18 |
| me and the notary public and acknowledged signing and
|
19 |
| delivering the instrument as the free and voluntary act of the |
20 |
| principal, for
the
uses and purposes therein set forth. I |
21 |
| believe him or her to be of sound mind
and memory. The |
22 |
| undersigned witness also certifies that the witness is not: (a) |
23 |
| the attending physician or mental health service provider or a |
24 |
| relative of the physician or provider; (b) an owner, operator, |
|
|
|
HB6477 Enrolled |
- 32 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| or relative of an owner or operator of a health care facility |
2 |
| in which the principal is a patient or resident; (c) a parent, |
3 |
| sibling, descendant, or any spouse of such parent, sibling, or |
4 |
| descendant of either the principal or any agent or successor |
5 |
| agent under the foregoing power of attorney, whether such |
6 |
| relationship is by blood, marriage, or adoption; or (d) an |
7 |
| agent or successor agent under the foregoing power of attorney.
|
8 |
| Dated: ................
|
9 |
| ..............................
|
10 |
| Witness
|
11 |
| (NOTE: Illinois requires only one witness, but other |
12 |
| jurisdictions may require more than one witness. If you wish to |
13 |
| have a second witness, have him or her certify and sign here:) |
14 |
| (Second witness) The undersigned witness certifies that |
15 |
| ................, known to me to be the same person whose name |
16 |
| is subscribed as principal to the foregoing power of attorney, |
17 |
| appeared before me and the notary public and acknowledged |
18 |
| signing and delivering the instrument as the free and voluntary |
19 |
| act of the principal, for the uses and purposes therein set |
20 |
| forth. I believe him or her to be of sound mind and memory. The |
21 |
| undersigned witness also certifies that the witness is not: (a) |
22 |
| the attending physician or mental health service provider or a |
23 |
| relative of the physician or provider; (b) an owner, operator, |
24 |
| or relative of an owner or operator of a health care facility |
|
|
|
HB6477 Enrolled |
- 33 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| in which the principal is a patient or resident; (c) a parent, |
2 |
| sibling, descendant, or any spouse of such parent, sibling, or |
3 |
| descendant of either the principal or any agent or successor |
4 |
| agent under the foregoing power of attorney, whether such |
5 |
| relationship is by blood, marriage, or adoption; or (d) an |
6 |
| agent or successor agent under the foregoing power of attorney. |
7 |
| Dated: ....................... |
8 |
| ..............................
|
9 |
| Witness
|
10 |
| State of ............)
|
11 |
| ) SS.
|
12 |
| County of ...........)
|
13 |
| The undersigned, a notary public in and for the above |
14 |
| county and state,
certifies that ......................., |
15 |
| known to me to be the same person
whose name is subscribed as |
16 |
| principal to the foregoing power of attorney,
appeared before |
17 |
| me and the witness(es) ............. (and ..............) |
18 |
| additional witness in person and acknowledged
signing and |
19 |
| delivering the
instrument as the free and voluntary act of the |
20 |
| principal, for the uses and
purposes therein set forth (, and |
21 |
| certified to the correctness of the
signature(s) of the |
22 |
| agent(s)).
|
23 |
| Dated: ................ (SEAL)
|
24 |
| ..............................
|
25 |
| Notary Public
|
|
|
|
HB6477 Enrolled |
- 34 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| My commission expires .................
|
2 |
| (NOTE: You may, but are not required to, request your agent and |
3 |
| successor agents to provide specimen signatures below. If you |
4 |
| include specimen signatures in this power of attorney, you must |
5 |
| complete the certification opposite the signatures of the |
6 |
| agents.)
|
7 |
| Specimen signatures of I certify that the signatures
|
8 |
| agent (and successors) of my agent (and successors)
|
9 |
| are genuine.
|
10 |
| .......................... .............................
|
11 |
| (agent) (principal)
|
12 |
| .......................... .............................
|
13 |
| (successor agent) (principal)
|
14 |
| .......................... .............................
|
15 |
| (successor agent) (principal) |
16 |
| The undersigned witness certifies that ................, known |
17 |
| to me to be
the same person whose name is subscribed as |
18 |
| principal to the foregoing power of
attorney, appeared before |
19 |
| me and the notary public and acknowledged signing and
|
20 |
| delivering the instrument as the free and voluntary act of the |
21 |
| principal, for
the
uses and purposes therein set forth. I |
22 |
| believe him or her to be of sound mind
and memory.
|
23 |
| Dated: ................ (SEAL)
|
|
|
|
HB6477 Enrolled |
- 35 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| ..............................
|
2 |
| Witness
|
3 |
| (NOTE: The name, address, and phone number of the person |
4 |
| preparing this form or who assisted the principal in completing |
5 |
| this form should be inserted below.) (THE NAME AND ADDRESS OF |
6 |
| THE PERSON PREPARING THIS FORM SHOULD BE
INSERTED
IF THE AGENT |
7 |
| WILL HAVE POWER TO CONVEY ANY INTEREST IN REAL ESTATE.)
|
8 |
| Name: ....................... |
9 |
| Address: .................... |
10 |
| .............................. |
11 |
| .............................. |
12 |
| Phone: .................... |
13 |
| This document was prepared by:
|
14 |
| .............................................................
|
15 |
| ............................................................."
|
16 |
| (e) Notice to Agent. The following form may be known as |
17 |
| "Notice to Agent" and shall be supplied to an agent appointed |
18 |
| under a power of attorney for property. |
19 |
| "NOTICE TO AGENT |
20 |
| When you accept the authority granted under this power of |
21 |
| attorney a special legal relationship, known as agency, is |
22 |
| created between you and the principal. Agency imposes upon you |
23 |
| duties that continue until you resign or the power of attorney |
|
|
|
HB6477 Enrolled |
- 36 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| is terminated or revoked. |
2 |
| As agent you must: |
3 |
| (1) do what you know the principal reasonably expects |
4 |
| you to do with the principal's property; |
5 |
| (2) act in good faith for the best interest of the |
6 |
| principal, using due care, competence, and diligence; |
7 |
| (3) keep a complete and detailed record of all |
8 |
| receipts, disbursements, and significant actions conducted |
9 |
| for the principal; |
10 |
| (4) attempt to preserve the principal's estate plan, to |
11 |
| the extent actually known by the agent, if preserving the |
12 |
| plan is consistent with the principal's best interest; and |
13 |
| (5) cooperate with a person who has authority to make |
14 |
| health care decisions for the principal to carry out the |
15 |
| principal's reasonable expectations to the extent actually |
16 |
| in the principal's best interest. |
17 |
| As agent you must not do any of the following: |
18 |
| (1) act so as to create a conflict of interest that is |
19 |
| inconsistent with the other principles in this Notice to |
20 |
| Agent; |
21 |
| (2) do any act beyond the authority granted in this |
22 |
| power of attorney; |
23 |
| (3) commingle the principal's funds with your funds; |
24 |
| (4) borrow funds or other property from the principal, |
25 |
| unless otherwise authorized; |
26 |
| (5) continue acting on behalf of the principal if you |
|
|
|
HB6477 Enrolled |
- 37 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| learn of any event that terminates this power of attorney |
2 |
| or your authority under this power of attorney, such as the |
3 |
| death of the principal, your legal separation from the |
4 |
| principal, or the dissolution of your marriage to the |
5 |
| principal. |
6 |
| If you have special skills or expertise, you must use those |
7 |
| special skills and expertise when acting for the principal. You |
8 |
| must disclose your identity as an agent whenever you act for |
9 |
| the principal by writing or printing the name of the principal |
10 |
| and signing your own name "as Agent" in the following manner: |
11 |
| "(Principal's Name) by (Your Name) as Agent" |
12 |
| The meaning of the powers granted to you is contained in |
13 |
| Section 3-4 of the Illinois Power of Attorney Act, which is |
14 |
| incorporated by reference into the body of the power of |
15 |
| attorney for property document. |
16 |
| If you violate your duties as agent or act outside the |
17 |
| authority granted to you, you may be liable for any damages, |
18 |
| including attorney's fees and costs, caused by your violation. |
19 |
| If there is anything about this document or your duties |
20 |
| that you do not understand, you should seek legal advice from |
21 |
| an attorney." |
22 |
| (f) The requirement of the signature of a witness in |
23 |
| addition to the principal and the notary, an additional
witness |
24 |
| imposed by Public Act 91-790, this amendatory Act of the 91st |
25 |
| General
Assembly applies only to instruments executed on or |
|
|
|
HB6477 Enrolled |
- 38 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| after June 9, 2000 ( the effective date of that Public Act). |
2 |
| this amendatory Act of the 91st
General Assembly. |
3 |
| (NOTE: This amendatory Act of the 96th General Assembly deletes |
4 |
| provisions that referred to the one required witness as an |
5 |
| "additional witness", and it also provides for the signature of |
6 |
| an optional "second witness".)
|
7 |
| (Source: P.A. 91-790, eff. 6-9-00 .)
|
8 |
| (755 ILCS 45/3-3.6 new) |
9 |
| Sec. 3-3.6. Limitations on who may witness property powers. |
10 |
| (a) Every property power shall bear the signature of a |
11 |
| witness to the signing of the agency and shall be notarized. |
12 |
| None of the following may serve as a witness to the signing of |
13 |
| a property power or as a notary public notarizing the property |
14 |
| power: |
15 |
| (1) the attending physician or mental health service |
16 |
| provider of the principal, or a relative of the physician |
17 |
| or provider; |
18 |
| (2) an owner, operator, or relative of an owner or |
19 |
| operator of a health care facility in which the principal |
20 |
| is a patient or resident; |
21 |
| (3) a parent, sibling, or descendant, or the spouse of |
22 |
| a parent, sibling, or descendant, of either the principal |
23 |
| or any agent or successor agent, regardless of whether the |
24 |
| relationship is by blood, marriage, or adoption; |
25 |
| (4) an agent or successor agent for property. |
|
|
|
HB6477 Enrolled |
- 39 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| (b) The prohibition on the operator of a health care |
2 |
| facility from serving as a witness shall extend to directors |
3 |
| and executive officers of an operator that is a corporate |
4 |
| entity but not other employees of the operator.
|
5 |
| (755 ILCS 45/3-4) (from Ch. 110 1/2, par. 803-4)
|
6 |
| Sec. 3-4. Explanation of powers granted in the statutory |
7 |
| short form power
of attorney for property. This Section defines |
8 |
| each category of powers
listed in the statutory short form |
9 |
| power of attorney for property and the
effect of granting |
10 |
| powers to an agent , and is incorporated by reference into the |
11 |
| statutory short form. Incorporation by reference does not |
12 |
| require physical attachment of a copy of this Section 3-4 to |
13 |
| the statutory short form power of attorney for property . When |
14 |
| the title of any of the
following categories is retained (not |
15 |
| struck out) in a statutory property
power form, the effect will |
16 |
| be to grant the agent all of the principal's
rights, powers and |
17 |
| discretions with respect to the types of property and
|
18 |
| transactions covered by the retained category, subject to any |
19 |
| limitations
on the granted powers that appear on the face of |
20 |
| the form. The agent will
have authority to exercise each |
21 |
| granted power for and in the name of the
principal with respect |
22 |
| to all of the principal's interests in every type of
property |
23 |
| or transaction covered by the granted power at the time of
|
24 |
| exercise, whether the principal's interests are direct or |
25 |
| indirect, whole
or fractional, legal, equitable or |
|
|
|
HB6477 Enrolled |
- 40 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| contractual, as a joint tenant or tenant
in common or held in |
2 |
| any other form; but the agent will not have power under
any of |
3 |
| the statutory categories (a) through (o) to make gifts of the
|
4 |
| principal's property, to exercise powers to appoint to others |
5 |
| or to change
any beneficiary whom the principal has designated |
6 |
| to take the principal's
interests at death under any will, |
7 |
| trust, joint tenancy, beneficiary form
or contractual |
8 |
| arrangement. The agent will be under no duty to exercise
|
9 |
| granted powers or to assume control of or responsibility for |
10 |
| the
principal's property or affairs; but when granted powers |
11 |
| are exercised, the
agent will be required to use due care to |
12 |
| act in good faith for the benefit of
the principal using due |
13 |
| care, competence, and diligence in accordance with the terms of |
14 |
| the statutory property power
and will be liable for negligent |
15 |
| exercise. The agent may act in person or
through others |
16 |
| reasonably employed by the agent for that purpose and will
have |
17 |
| authority to sign and deliver all instruments, negotiate and |
18 |
| enter
into all agreements and do all other acts reasonably |
19 |
| necessary to implement
the exercise of the powers granted to |
20 |
| the agent.
|
21 |
| (a) Real estate transactions. The agent is authorized to: |
22 |
| buy,
sell, exchange, rent and lease real estate (which term |
23 |
| includes, without
limitation, real estate subject to a land |
24 |
| trust and all beneficial
interests in and powers of direction |
25 |
| under any land trust); collect all
rent, sale proceeds and |
26 |
| earnings from real estate; convey, assign and
accept title to |
|
|
|
HB6477 Enrolled |
- 41 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| real estate; grant easements, create conditions and release
|
2 |
| rights of homestead with respect to real estate; create land |
3 |
| trusts and
exercise all powers under land trusts; hold, |
4 |
| possess, maintain, repair,
improve, subdivide, manage, operate |
5 |
| and insure real estate; pay, contest,
protest and compromise |
6 |
| real estate taxes and assessments; and, in general,
exercise |
7 |
| all powers with respect to real estate which the principal |
8 |
| could
if present and under no disability.
|
9 |
| (b) Financial institution transactions. The agent is |
10 |
| authorized to:
open, close, continue and control all accounts |
11 |
| and deposits in any type of
financial institution (which term |
12 |
| includes, without limitation, banks,
trust companies, savings |
13 |
| and building and loan associations, credit unions
and brokerage |
14 |
| firms); deposit in and withdraw from and write checks on any
|
15 |
| financial institution account or deposit; and, in general, |
16 |
| exercise all
powers with respect to financial institution |
17 |
| transactions which the
principal could if present and under no |
18 |
| disability. This authorization shall also apply to any Totten |
19 |
| Trust, Payable on Death Account, or comparable trust account |
20 |
| arrangement where the terms of such trust are contained |
21 |
| entirely on the financial institution's signature card, |
22 |
| insofar as an agent shall be permitted to withdraw income or |
23 |
| principal from such account, unless this authorization is |
24 |
| expressly limited or withheld under paragraph 2 of the form |
25 |
| prescribed under Section 3-3. This authorization shall not |
26 |
| apply to accounts titled in the name of any trust subject to |
|
|
|
HB6477 Enrolled |
- 42 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| the provisions of the Trusts and Trustees Act, for which |
2 |
| specific reference to the trust and a specific grant of |
3 |
| authority to the agent to withdraw income or principal from |
4 |
| such trust is required pursuant to Section 2-9 of the Illinois |
5 |
| Power of Attorney Act and subsection (n) of this Section.
|
6 |
| (c) Stock and bond transactions. The agent is authorized |
7 |
| to: buy
and sell all types of securities (which term includes, |
8 |
| without limitation,
stocks, bonds, mutual funds and all other |
9 |
| types of investment securities
and financial instruments); |
10 |
| collect, hold and safekeep all dividends,
interest, earnings, |
11 |
| proceeds of sale, distributions, shares, certificates
and |
12 |
| other evidences of ownership paid or distributed with respect |
13 |
| to
securities; exercise all voting rights with respect to |
14 |
| securities in person
or by proxy, enter into voting trusts and |
15 |
| consent to limitations on the
right to vote; and, in general, |
16 |
| exercise all powers with respect to
securities which the |
17 |
| principal could if present and under no disability.
|
18 |
| (d) Tangible personal property transactions. The agent is
|
19 |
| authorized to: buy and sell, lease, exchange, collect, possess |
20 |
| and take
title to all tangible personal property; move, store, |
21 |
| ship, restore,
maintain, repair, improve, manage, preserve, |
22 |
| insure and safekeep tangible
personal property; and, in |
23 |
| general, exercise all powers with respect to
tangible personal |
24 |
| property which the principal could if present and under no |
25 |
| disability.
|
26 |
| (e) Safe deposit box transactions. The agent is authorized |
|
|
|
HB6477 Enrolled |
- 43 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| to:
open, continue and have access to all safe deposit boxes; |
2 |
| sign, renew,
release or terminate any safe deposit contract; |
3 |
| drill or surrender any safe
deposit box; and, in general, |
4 |
| exercise all powers with respect to safe
deposit matters which |
5 |
| the principal could if present and under no disability.
|
6 |
| (f) Insurance and annuity transactions. The agent is |
7 |
| authorized to:
procure, acquire, continue, renew, terminate or |
8 |
| otherwise deal with any
type of insurance or annuity contract |
9 |
| (which terms include, without
limitation, life, accident, |
10 |
| health, disability, automobile casualty,
property or liability |
11 |
| insurance); pay premiums or assessments on or
surrender and |
12 |
| collect all distributions, proceeds or benefits payable under
|
13 |
| any insurance or annuity contract; and, in general, exercise |
14 |
| all powers
with respect to insurance and annuity contracts |
15 |
| which the principal could
if present and under no disability.
|
16 |
| (g) Retirement plan transactions. The agent is authorized |
17 |
| to:
contribute to, withdraw from and deposit funds in any type |
18 |
| of retirement
plan (which term includes, without limitation, |
19 |
| any tax qualified or
nonqualified pension, profit sharing, |
20 |
| stock bonus, employee savings and
other retirement plan, |
21 |
| individual retirement account, deferred compensation
plan and |
22 |
| any other type of employee benefit plan); select and change
|
23 |
| payment options for the principal under any retirement plan; |
24 |
| make rollover
contributions from any retirement plan to other |
25 |
| retirement plans or
individual retirement accounts; exercise |
26 |
| all investment powers available
under any type of self-directed |
|
|
|
HB6477 Enrolled |
- 44 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| retirement plan; and, in general, exercise
all powers with |
2 |
| respect to retirement plans and retirement plan account
|
3 |
| balances which the principal could if present and under no |
4 |
| disability.
|
5 |
| (h) Social Security, unemployment and military service |
6 |
| benefits.
The agent is authorized to: prepare, sign and file |
7 |
| any claim or application
for Social Security, unemployment or |
8 |
| military service benefits; sue for,
settle or abandon any |
9 |
| claims to any benefit or assistance under any
federal, state, |
10 |
| local or foreign statute or regulation; control, deposit to
any |
11 |
| account, collect, receipt for, and take title to and hold all |
12 |
| benefits
under any Social Security, unemployment, military |
13 |
| service or other state,
federal, local or foreign statute or |
14 |
| regulation; and, in general, exercise
all powers with respect |
15 |
| to Social Security, unemployment, military service
and |
16 |
| governmental benefits which the principal could if present and |
17 |
| under no disability.
|
18 |
| (i) Tax matters. The agent is authorized to: sign, verify |
19 |
| and file
all the principal's federal, state and local income, |
20 |
| gift, estate, property
and other tax returns, including joint |
21 |
| returns and declarations of
estimated tax; pay all taxes; |
22 |
| claim, sue for and receive all tax refunds;
examine and copy |
23 |
| all the principal's tax returns and records; represent the
|
24 |
| principal before any federal, state or local revenue agency or |
25 |
| taxing body
and sign and deliver all tax powers of attorney on |
26 |
| behalf of the principal
that may be necessary for such |
|
|
|
HB6477 Enrolled |
- 45 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| purposes; waive rights and sign all
documents on behalf of the |
2 |
| principal as required to settle, pay and
determine all tax |
3 |
| liabilities; and, in general, exercise all powers with
respect |
4 |
| to tax matters which the principal could if present and under |
5 |
| no disability.
|
6 |
| (j) Claims and litigation. The agent is authorized to: |
7 |
| institute,
prosecute, defend, abandon, compromise, arbitrate, |
8 |
| settle and dispose of
any claim in favor of or against the |
9 |
| principal or any property interests of
the principal; collect |
10 |
| and receipt for any claim or settlement proceeds and
waive or |
11 |
| release all rights of the principal; employ attorneys and |
12 |
| others
and enter into contingency agreements and other |
13 |
| contracts as necessary in
connection with litigation; and, in |
14 |
| general, exercise all powers with
respect to claims and |
15 |
| litigation which the principal could if present and
under no |
16 |
| disability. The statutory short form power
of attorney for |
17 |
| property does not authorize the agent to appear in court or any |
18 |
| tribunal as an attorney-at-law for the principal or otherwise |
19 |
| to engage in the practice of law without being a licensed |
20 |
| attorney who is authorized to practice law in Illinois under |
21 |
| applicable Illinois Supreme Court Rules.
|
22 |
| (k) Commodity and option transactions. The agent is |
23 |
| authorized to:
buy, sell, exchange, assign, convey, settle and |
24 |
| exercise commodities
futures contracts and call and put options |
25 |
| on stocks and stock indices
traded on a regulated options |
26 |
| exchange and collect and receipt for all
proceeds of any such |
|
|
|
HB6477 Enrolled |
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LRB096 21113 AJO 36964 b |
|
|
1 |
| transactions; establish or continue option accounts
for the |
2 |
| principal with any securities or futures broker; and, in |
3 |
| general,
exercise all powers with respect to commodities and |
4 |
| options which the
principal could if present and under no |
5 |
| disability.
|
6 |
| (l) Business operations. The agent is authorized to: |
7 |
| organize or
continue and conduct any business (which term |
8 |
| includes, without limitation,
any farming, manufacturing, |
9 |
| service, mining, retailing or other type of
business operation) |
10 |
| in any form, whether as a proprietorship, joint
venture, |
11 |
| partnership, corporation, trust or other legal entity; |
12 |
| operate,
buy, sell, expand, contract, terminate or liquidate |
13 |
| any business; direct,
control, supervise, manage or |
14 |
| participate in the operation of any business
and engage, |
15 |
| compensate and discharge business managers, employees, agents,
|
16 |
| attorneys, accountants and consultants; and, in general, |
17 |
| exercise all
powers with respect to business interests and |
18 |
| operations which the principal
could if present and under no |
19 |
| disability.
|
20 |
| (m) Borrowing transactions. The agent is authorized to: |
21 |
| borrow
money; mortgage or pledge any real estate or tangible or |
22 |
| intangible
personal property as security for such purposes; |
23 |
| sign, renew, extend, pay
and satisfy any notes or other forms |
24 |
| of obligation; and, in general,
exercise all powers with |
25 |
| respect to secured and unsecured borrowing which
the principal |
26 |
| could if present and under no disability.
|
|
|
|
HB6477 Enrolled |
- 47 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| (n) Estate transactions. The agent is authorized to: |
2 |
| accept,
receipt for, exercise, release, reject, renounce, |
3 |
| assign, disclaim, demand,
sue for, claim and recover any |
4 |
| legacy, bequest, devise, gift or other
property interest or |
5 |
| payment due or payable to or for the principal; assert
any |
6 |
| interest in and exercise any power over any trust, estate or |
7 |
| property
subject to fiduciary control; establish a revocable |
8 |
| trust solely for the
benefit of the principal that terminates |
9 |
| at the death of the principal and
is then distributable to the |
10 |
| legal representative of the estate of the
principal; and, in |
11 |
| general, exercise all powers with respect to estates and
trusts |
12 |
| which the principal could if present and under no disability;
|
13 |
| provided, however, that the agent may not make or change a will |
14 |
| and may not
revoke or amend a trust revocable or amendable by |
15 |
| the principal or require
the trustee of any trust for the |
16 |
| benefit of the principal to pay income or
principal to the |
17 |
| agent unless specific authority to that end is given, and
|
18 |
| specific reference to the trust is made, in the statutory |
19 |
| property power form.
|
20 |
| (o) All other property powers and transactions. The agent |
21 |
| is
authorized to: exercise all possible authority powers of the |
22 |
| principal with respect
to all possible types of property and |
23 |
| interests in property, except to the
extent limited in |
24 |
| subsections (a) through (n) of this Section 3-4 and to the |
25 |
| extent that the principal otherwise limits the generality of |
26 |
| this category (o) by striking
out one or more of categories (a) |
|
|
|
HB6477 Enrolled |
- 48 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| through (n) or by specifying other
limitations in the statutory |
2 |
| property power form.
|
3 |
| (Source: P.A. 94-938, eff. 1-1-07.)
|
4 |
| (755 ILCS 45/3-5 new) |
5 |
| Sec. 3-5. Savings clause. This amendatory Act of the 96th |
6 |
| General Assembly does not in any way invalidate any property |
7 |
| power executed or any act of any agent done, or affect any |
8 |
| claim, right, or remedy that accrued, prior to the effective |
9 |
| date of this amendatory Act of the 96th General Assembly.
|
10 |
| (755 ILCS 45/4-4) (from Ch. 110 1/2, par. 804-4)
|
11 |
| Sec. 4-4. Definitions. As used in this Article:
|
12 |
| (a) "Attending physician" means the physician who has |
13 |
| primary
responsibility at the time of reference for the |
14 |
| treatment and care of the patient.
|
15 |
| (b) "Health care" means any care, treatment, service or |
16 |
| procedure to
maintain, diagnose, treat or provide for the |
17 |
| patient's physical or mental
health or personal care.
|
18 |
| (c) "Health care agency" means an agency governing any type |
19 |
| of health
care, anatomical gift, autopsy or disposition of |
20 |
| remains for and on behalf
of a patient and refers to the power |
21 |
| of attorney or other written
instrument defining the agency or |
22 |
| the agency, itself, as appropriate to the context.
|
23 |
| (d) "Health care provider" or "provider" means the |
24 |
| attending physician
and any other person administering health |
|
|
|
HB6477 Enrolled |
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LRB096 21113 AJO 36964 b |
|
|
1 |
| care to the patient at the time
of reference who is licensed, |
2 |
| certified, or otherwise authorized or
permitted by law to |
3 |
| administer health care in the ordinary course of
business or |
4 |
| the practice of a profession, including any person employed by
|
5 |
| or acting for any such authorized person.
|
6 |
| (e) "Patient" means the principal or, if the agency governs |
7 |
| health care
for a minor child of the principal, then the child.
|
8 |
| (f) "Incurable or irreversible condition" means an illness |
9 |
| or injury (i) for which there is no reasonable prospect of cure |
10 |
| or recovery, (ii) that ultimately will cause the patient's |
11 |
| death even if life-sustaining treatment is initiated or |
12 |
| continued, (iii) that imposes severe pain or otherwise imposes |
13 |
| an inhumane burden on the patient, or (iv) for which initiating |
14 |
| or continuing life-sustaining treatment, in light of the |
15 |
| patient's medical condition, provides only minimal medical |
16 |
| benefit. |
17 |
| (g) "Permanent unconsciousness" means a condition that, to |
18 |
| a high degree of medical certainty, (i) will last permanently, |
19 |
| without improvement, (ii) in which thought, sensation, |
20 |
| purposeful action, social interaction, and awareness of self |
21 |
| and environment are absent, and (iii) for which initiating or |
22 |
| continuing life-sustaining treatment, in light of the |
23 |
| patient's medical condition, provides only minimal medical |
24 |
| benefit. For the purposes of this definition, "medical benefit" |
25 |
| means a chance to cure or reverse a condition. |
26 |
| (h) "Terminal condition" means an illness or injury for |
|
|
|
HB6477 Enrolled |
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LRB096 21113 AJO 36964 b |
|
|
1 |
| which there is no reasonable prospect of cure or recovery, |
2 |
| death is imminent, and the application of life-sustaining |
3 |
| treatment would only prolong the dying process. |
4 |
| (Source: P.A. 85-701.)
|
5 |
| (755 ILCS 45/4-5.1 new) |
6 |
| Sec. 4-5.1. Limitations on who may witness health care |
7 |
| agencies. |
8 |
| (a) Every health care agency shall bear the signature of a |
9 |
| witness to the signing of the agency. None of the following may |
10 |
| serve as a witness to the signing of a health care agency: |
11 |
| (1) the attending physician or mental health service |
12 |
| provider of the principal, or a relative of the physician |
13 |
| or provider; |
14 |
| (2) an owner, operator, or relative of an owner or |
15 |
| operator of a health care facility in which the principal |
16 |
| is a patient or resident; |
17 |
| (3) a parent, sibling, or descendant, or the spouse of |
18 |
| a parent, sibling, or descendant, of either the principal |
19 |
| or any agent or successor agent, regardless of whether the |
20 |
| relationship is by blood, marriage, or adoption; |
21 |
| (4) an agent or successor agent for health care. |
22 |
| (b) The prohibition on the operator of a health care |
23 |
| facility from serving as a witness shall extend to directors |
24 |
| and executive officers of an operator that is a corporate |
25 |
| entity but not other employees of the operator.
|
|
|
|
HB6477 Enrolled |
- 51 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| (755 ILCS 45/4-10) (from Ch. 110 1/2, par. 804-10)
|
2 |
| Sec. 4-10. Statutory short form power of attorney for |
3 |
| health care.
|
4 |
| (a) The following form prescribed in this Section |
5 |
| (sometimes also referred to in this Act as the
"statutory |
6 |
| health care power") may be used to grant an agent powers with
|
7 |
| respect to the principal's own health care; but the statutory |
8 |
| health care
power is not intended to be exclusive nor to cover |
9 |
| delegation of a parent's
power to control the health care of a |
10 |
| minor child, and no provision of this
Article shall be |
11 |
| construed to invalidate or bar use by the principal of any
|
12 |
| other or
different form of power of attorney for health care. |
13 |
| Nonstatutory health
care powers must be
executed by the |
14 |
| principal, designate the agent and the agent's powers, and
|
15 |
| comply with Section 4-5 of this Article, but they need not be |
16 |
| witnessed or
conform in any other respect to the statutory |
17 |
| health care power. When a
power of attorney in substantially |
18 |
| the
following form prescribed in this Section is used, |
19 |
| including the "Notice to the Individual Signing the Illinois |
20 |
| Statutory Short Form Power of Attorney for Health Care" (or |
21 |
| "Notice" paragraphs) "notice" paragraph at the beginning of the |
22 |
| form on a separate sheet in 14-point type
in capital letters , |
23 |
| it shall have the meaning and effect prescribed in this
Act. A |
24 |
| power of attorney for health care shall be deemed to be in |
25 |
| substantially the same format as the statutory form if the |
|
|
|
HB6477 Enrolled |
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LRB096 21113 AJO 36964 b |
|
|
1 |
| explanatory language throughout the form (the language |
2 |
| following the designation "NOTE:") is distinguished in some way |
3 |
| from the legal paragraphs in the form, such as the use of |
4 |
| boldface or other difference in typeface and font or point |
5 |
| size, even if the "Notice" paragraphs at the beginning are not |
6 |
| on a separate sheet of paper or are not in 14-point type, or if |
7 |
| the principal's initials do not appear in the acknowledgement |
8 |
| at the end of the "Notice" paragraphs. The statutory health |
9 |
| care power may be included in or
combined with any
other form |
10 |
| of power of attorney governing property or other matters.
|
11 |
| (b) The Illinois Statutory Short Form Power of Attorney for |
12 |
| Health Care shall be substantially as follows: |
13 |
| "NOTICE TO THE INDIVIDUAL SIGNING THE ILLINOIS |
14 |
| STATUTORY SHORT FORM POWER OF ATTORNEY FOR HEALTH CARE |
15 |
| PLEASE READ THIS NOTICE CAREFULLY. The form that you will |
16 |
| be signing is a legal document. It is governed by the Illinois |
17 |
| Power of Attorney Act. If there is anything about this form |
18 |
| that you do not understand, you should ask a lawyer to explain |
19 |
| it to you. |
20 |
| The purpose of this Power of Attorney is to give your |
21 |
| designated "agent" broad powers to make health care decisions |
22 |
| for you, including the power to require, consent to, or |
23 |
| withdraw treatment for any physical or mental condition, and to |
24 |
| admit you or discharge you from any hospital, home, or other |
|
|
|
HB6477 Enrolled |
- 53 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| institution. You may name successor agents under this form, but |
2 |
| you may not name co-agents. |
3 |
| This form does not impose a duty upon your agent to make |
4 |
| such health care decisions, so it is important that you select |
5 |
| an agent who will agree to do this for you and who will make |
6 |
| those decisions as you would wish. It is also important to |
7 |
| select an agent whom you trust, since you are giving that agent |
8 |
| control over your medical decision-making, including |
9 |
| end-of-life decisions. Any agent who does act for you has a |
10 |
| duty to act in good faith for your benefit and to use due care, |
11 |
| competence, and diligence. He or she must also act in |
12 |
| accordance with the law and with the statements in this form. |
13 |
| Your agent must keep a record of all significant actions taken |
14 |
| as your agent. |
15 |
| Unless you specifically limit the period of time that this |
16 |
| Power of Attorney will be in effect, your agent may exercise |
17 |
| the powers given to him or her throughout your lifetime, even |
18 |
| after you become disabled. A court, however, can take away the |
19 |
| powers of your agent if it finds that the agent is not acting |
20 |
| properly. You may also revoke this Power of Attorney if you |
21 |
| wish. |
22 |
| The Powers you give your agent, your right to revoke those |
23 |
| powers, and the penalties for violating the law are explained |
24 |
| more fully in Sections 4-5, 4-6, and 4-10(b) of the Illinois |
25 |
| Power of Attorney Act. This form is a part of that law. The |
26 |
| "NOTE" paragraphs throughout this form are instructions. |
|
|
|
HB6477 Enrolled |
- 54 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| You are not required to sign this Power of Attorney, but it |
2 |
| will not take effect without your signature. You should not |
3 |
| sign it if you do not understand everything in it, and what |
4 |
| your agent will be able to do if you do sign it. |
5 |
| Please put your initials on the following line indicating |
6 |
| that you have read this Notice: |
7 |
| ......................
|
8 |
| (Principal's initials)"
|
9 |
| "ILLINOIS STATUTORY SHORT FORM |
10 |
| POWER OF ATTORNEY FOR HEALTH CARE
|
11 |
| (NOTICE: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE |
12 |
| THE PERSON YOU
DESIGNATE (YOUR "AGENT") BROAD POWERS TO MAKE |
13 |
| HEALTH CARE DECISIONS FOR YOU,
INCLUDING POWER TO REQUIRE, |
14 |
| CONSENT TO OR WITHDRAW ANY TYPE OF PERSONAL
CARE OR MEDICAL |
15 |
| TREATMENT FOR ANY PHYSICAL OR MENTAL CONDITION AND TO ADMIT
YOU |
16 |
| TO OR DISCHARGE YOU FROM ANY HOSPITAL, HOME OR OTHER |
17 |
| INSTITUTION. THIS
FORM DOES NOT IMPOSE A DUTY ON YOUR AGENT TO |
18 |
| EXERCISE GRANTED POWERS; BUT
WHEN POWERS ARE EXERCISED, YOUR |
19 |
| AGENT WILL HAVE TO USE
DUE CARE TO ACT FOR
YOUR BENEFIT AND IN |
20 |
| ACCORDANCE WITH THIS FORM AND KEEP A RECORD OF
RECEIPTS, |
21 |
| DISBURSEMENTS AND SIGNIFICANT ACTIONS TAKEN AS AGENT. A COURT
|
22 |
| CAN TAKE AWAY THE
POWERS OF YOUR AGENT IF IT FINDS THE AGENT IS |
23 |
| NOT ACTING PROPERLY. YOU MAY
NAME SUCCESSOR AGENTS UNDER THIS |
|
|
|
HB6477 Enrolled |
- 55 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| FORM
BUT NOT CO-AGENTS, AND NO HEALTH CARE PROVIDER MAY BE |
2 |
| NAMED. UNLESS
YOU EXPRESSLY LIMIT THE DURATION OF THIS POWER
IN |
3 |
| THE MANNER PROVIDED BELOW, UNTIL YOU REVOKE THIS POWER OR A |
4 |
| COURT ACTING
ON YOUR BEHALF TERMINATES IT, YOUR AGENT MAY |
5 |
| EXERCISE THE POWERS GIVEN HERE
THROUGHOUT YOUR LIFETIME, EVEN |
6 |
| AFTER YOU BECOME DISABLED. THE POWERS YOU
GIVE YOUR AGENT, YOUR |
7 |
| RIGHT TO REVOKE THOSE POWERS AND THE PENALTIES FOR
VIOLATING |
8 |
| THE LAW ARE EXPLAINED MORE FULLY IN SECTIONS 4-5, 4-6, 4-9 AND
|
9 |
| 4-10(b) OF THE ILLINOIS
"POWERS OF ATTORNEY FOR HEALTH CARE |
10 |
| LAW"
OF WHICH THIS FORM IS A PART (SEE THE BACK OF THIS FORM). |
11 |
| THAT LAW
EXPRESSLY PERMITS THE USE OF ANY DIFFERENT FORM OF |
12 |
| POWER OF ATTORNEY YOU
MAY DESIRE. IF THERE IS ANYTHING ABOUT |
13 |
| THIS FORM THAT YOU DO NOT
UNDERSTAND, YOU SHOULD ASK A LAWYER |
14 |
| TO EXPLAIN IT TO YOU.)
|
15 |
| POWER OF ATTORNEY made this .......................day of
|
16 |
| ................................
|
17 |
| (month) (year)
|
18 |
| 1. I, ..................................................,
|
19 |
| (insert name and address of principal)
hereby revoke all prior |
20 |
| powers of attorney for health care executed by me and appoint:
|
21 |
| ............................................................
|
22 |
| (insert name and address of agent)
|
23 |
| (NOTE: You may not name co-agents using this form.) |
24 |
| as my attorney-in-fact (my "agent") to act for me and in my |
25 |
| name (in any
way I could act in person) to make any and all |
26 |
| decisions for me concerning
my personal care, medical |
|
|
|
HB6477 Enrolled |
- 56 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| treatment, hospitalization and health care and to
require, |
2 |
| withhold or withdraw any type of medical treatment or |
3 |
| procedure,
even though my death may ensue. |
4 |
| A. My agent shall have the same access to my
medical |
5 |
| records that I have, including the right to disclose the |
6 |
| contents
to others. My agent shall also have full power to
|
7 |
| authorize an autopsy and direct the disposition of my remains. |
8 |
| B.
Effective upon my death, my agent has the full power to |
9 |
| make an anatomical
gift of the following (initial one) : |
10 |
| (NOTE: Initial one. In the event none of the options are |
11 |
| initialed, then it shall be concluded that you do not wish to |
12 |
| grant your agent any such authority.)
|
13 |
| .... Any organs, tissues, or eyes suitable for |
14 |
| transplantation or used for
research or education.
|
15 |
| .... Specific organs: ................................
|
16 |
| .... I do not grant my agent authority to make any |
17 |
| anatomical gifts. |
18 |
| C. My agent shall also have full power to authorize an |
19 |
| autopsy and direct the disposition of my remains. I intend for |
20 |
| this power of attorney to be in substantial compliance with |
21 |
| Section 10 of the Disposition of Remains Act. All decisions |
22 |
| made by my agent with respect to the disposition of my remains, |
23 |
| including cremation, shall be binding. I hereby direct any |
24 |
| cemetery organization, business operating a crematory or |
25 |
| columbarium or both, funeral director or embalmer, or funeral |
26 |
| establishment who receives a copy of this document to act under |
|
|
|
HB6477 Enrolled |
- 57 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| it. |
2 |
| D. I intend for the person named as my agent to be treated |
3 |
| as I would be with respect to my rights regarding the use and |
4 |
| disclosure of my individually identifiable health information |
5 |
| or other medical records, including records or communications |
6 |
| governed by the Mental Health and Developmental Disabilities |
7 |
| Confidentiality Act. This release authority applies to any |
8 |
| information governed by the Health Insurance Portability and |
9 |
| Accountability Act of 1996 ("HIPAA") and regulations |
10 |
| thereunder. I intend for the person named as my agent to serve |
11 |
| as my "personal representative" as that term is defined under |
12 |
| HIPAA and regulations thereunder. |
13 |
| (i) The person named as my agent shall have the power to |
14 |
| authorize the release of information governed by HIPAA to third |
15 |
| parties. |
16 |
| (ii) I authorize any physician, health care professional, |
17 |
| dentist, health plan, hospital, clinic, laboratory, pharmacy |
18 |
| or other covered health care provider, any insurance company |
19 |
| and the Medical Informational Bureau, Inc., or any other health |
20 |
| care clearinghouse that has provided treatment or services to |
21 |
| me, or that has paid for or is seeking payment for me for such |
22 |
| services to give, disclose, and release to the person named as |
23 |
| my agent, without restriction, all of my individually |
24 |
| identifiable health information and medical records, regarding |
25 |
| any past, present, or future medical or mental health |
26 |
| condition, including all information relating to the diagnosis |
|
|
|
HB6477 Enrolled |
- 58 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| and treatment of HIV/AIDS, sexually transmitted diseases, drug |
2 |
| or alcohol abuse, and mental illness (including records or |
3 |
| communications governed by the Mental Health and Developmental |
4 |
| Disabilities Confidentiality Act). |
5 |
| (iii) The authority given to the person named as my agent |
6 |
| shall supersede any prior agreement that I may have with my |
7 |
| health care providers to restrict access to, or disclosure of, |
8 |
| my individually identifiable health information. The authority |
9 |
| given to the person named as my agent has no expiration date |
10 |
| and shall expire only in the event that I revoke the authority |
11 |
| in writing and deliver it to my health care provider. The |
12 |
| authority given to the person named as my agent to serve as my |
13 |
| "personal representative" as defined under HIPAA and |
14 |
| regulations thereunder and to access my individually |
15 |
| identifiable health information or authorize the release of the |
16 |
| same to third parties shall take effect immediately, even if I |
17 |
| designate in Paragraph 3 of this document that this agency |
18 |
| shall otherwise take effect at some future date. |
19 |
| (NOTE: The above grant of power is intended to be as broad as |
20 |
| possible so that your agent will have the authority to make any |
21 |
| decision you could make to obtain or terminate any type of |
22 |
| health care, including withdrawal of food and water and other |
23 |
| life-sustaining measures, if your agent believes such action |
24 |
| would be consistent with your intent and desires. If you wish |
25 |
| to limit the scope of your agent's powers or prescribe special |
26 |
| rules or limit the power to make an anatomical gift, authorize |
|
|
|
HB6477 Enrolled |
- 59 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| autopsy or dispose of remains, you may do so in the following |
2 |
| paragraphs.) (THE ABOVE GRANT OF POWER IS INTENDED TO BE AS |
3 |
| BROAD AS POSSIBLE SO THAT
YOUR AGENT WILL HAVE AUTHORITY TO |
4 |
| MAKE ANY DECISION YOU COULD MAKE TO
OBTAIN OR TERMINATE ANY |
5 |
| TYPE OF HEALTH CARE, INCLUDING WITHDRAWAL OF FOOD
AND WATER AND |
6 |
| OTHER LIFE-SUSTAINING MEASURES, IF YOUR AGENT BELIEVES SUCH
|
7 |
| ACTION WOULD BE CONSISTENT WITH YOUR INTENT AND DESIRES. IF YOU |
8 |
| WISH TO
LIMIT THE SCOPE OF YOUR AGENT'S POWERS OR PRESCRIBE |
9 |
| SPECIAL RULES OR LIMIT
THE POWER TO MAKE AN ANATOMICAL GIFT, |
10 |
| AUTHORIZE AUTOPSY OR DISPOSE OF
REMAINS, YOU MAY DO SO IN THE |
11 |
| FOLLOWING PARAGRAPHS.)
|
12 |
| 2. The powers granted above shall not include the following |
13 |
| powers or
shall be subject to the following rules or |
14 |
| limitations : |
15 |
| (NOTE: Here (here you may include
any specific limitations you |
16 |
| deem appropriate, such as: your own
definition of when |
17 |
| life-sustaining measures should be withheld; a direction
to |
18 |
| continue food and fluids or life-sustaining treatment in
all |
19 |
| events; or instructions to refuse
any specific types of |
20 |
| treatment that are inconsistent with your religious
beliefs or |
21 |
| unacceptable to you for any other reason, such as blood
|
22 |
| transfusion, electro-convulsive therapy, amputation, |
23 |
| psychosurgery,
voluntary admission to a mental institution, |
24 |
| etc.) :
|
25 |
| .............................................................
|
26 |
| .............................................................
|
|
|
|
HB6477 Enrolled |
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LRB096 21113 AJO 36964 b |
|
|
1 |
| .............................................................
|
2 |
| .............................................................
|
3 |
| .............................................................
|
4 |
| (NOTE: The subject of life-sustaining treatment is of |
5 |
| particular importance. For your convenience in dealing with |
6 |
| that subject, some general statements concerning the |
7 |
| withholding or removal of life-sustaining treatment are set |
8 |
| forth below. If you agree with one of these statements, you may |
9 |
| initial that statement; but do not initial more than one. These |
10 |
| statements serve as guidance for your agent, who shall give |
11 |
| careful consideration to the statement you initial when |
12 |
| engaging in health care decision-making on your behalf.) (THE |
13 |
| SUBJECT OF LIFE-SUSTAINING TREATMENT IS OF PARTICULAR |
14 |
| IMPORTANCE. FOR
YOUR CONVENIENCE IN DEALING WITH THAT SUBJECT, |
15 |
| SOME GENERAL STATEMENTS
CONCERNING THE WITHHOLDING OR REMOVAL |
16 |
| OF LIFE-SUSTAINING TREATMENT ARE SET
FORTH BELOW. IF YOU AGREE |
17 |
| WITH ONE OF THESE STATEMENTS, YOU MAY
INITIAL THAT STATEMENT; |
18 |
| BUT DO NOT INITIAL MORE THAN ONE):
|
19 |
| I do not want my life to be prolonged nor do I want |
20 |
| life-sustaining
treatment to be provided or continued if my |
21 |
| agent believes the burdens of
the treatment outweigh the |
22 |
| expected benefits. I want my agent to consider
the relief of |
23 |
| suffering, the expense involved and the quality as well as
the |
24 |
| possible extension of my life in making decisions concerning
|
25 |
| life-sustaining treatment.
|
26 |
| Initialed ...........................
|
|
|
|
HB6477 Enrolled |
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LRB096 21113 AJO 36964 b |
|
|
1 |
| I want my life to be prolonged and I want life-sustaining |
2 |
| treatment to be
provided or continued , unless I am in a coma |
3 |
| which my attending physician
believes to be irreversible , in |
4 |
| the opinion of my attending physician, in accordance with |
5 |
| reasonable medical
standards at the time of reference , in a |
6 |
| state of "permanent unconsciousness" or suffer from an |
7 |
| "incurable or irreversible condition" or "terminal condition", |
8 |
| as those terms are defined in Section 4-4 of the Illinois Power |
9 |
| of Attorney Act . If and when I am in any one of these states or |
10 |
| conditions, I have suffered
irreversible coma, I want |
11 |
| life-sustaining treatment to be withheld or
discontinued.
|
12 |
| Initialed ...........................
|
13 |
| I want my life to be prolonged to the greatest extent |
14 |
| possible in accordance with reasonable medical standards |
15 |
| without
regard to my condition, the chances I have for recovery |
16 |
| or the cost of the
procedures.
|
17 |
| Initialed ...........................
|
18 |
| (NOTE: This power of attorney may be amended or revoked by you |
19 |
| in the manner provided in Section 4-6 of the Illinois Power of |
20 |
| Attorney Act. Your agent can act immediately, unless you |
21 |
| specify otherwise; but you cannot specify otherwise with |
22 |
| respect to your "personal representative" under subparagraph |
23 |
| D(iii).) (THIS POWER OF ATTORNEY MAY BE AMENDED OR REVOKED BY |
24 |
| YOU IN THE MANNER
PROVIDED IN SECTION 4-6 OF THE ILLINOIS |
25 |
| "POWERS OF ATTORNEY FOR HEALTH CARE
LAW" (SEE THE BACK OF THIS |
26 |
| FORM). ABSENT AMENDMENT OR
REVOCATION, THE AUTHORITY GRANTED IN |
|
|
|
HB6477 Enrolled |
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LRB096 21113 AJO 36964 b |
|
|
1 |
| THIS
POWER OF ATTORNEY WILL BECOME EFFECTIVE AT THE TIME THIS |
2 |
| POWER IS SIGNED
AND WILL CONTINUE UNTIL YOUR DEATH, AND BEYOND |
3 |
| IF ANATOMICAL GIFT, AUTOPSY
OR DISPOSITION OF REMAINS IS |
4 |
| AUTHORIZED, UNLESS A LIMITATION ON THE
BEGINNING DATE OR |
5 |
| DURATION IS MADE BY INITIALING AND COMPLETING EITHER OR
BOTH OF |
6 |
| THE FOLLOWING:)
|
7 |
| 3. ( ) This power of attorney shall become effective on
|
8 |
| .............................................................
|
9 |
| .............................................................
|
10 |
| ( NOTE: Insert insert a future date or event during your |
11 |
| lifetime, such as a court
determination of your disability or a |
12 |
| written determination by your physician that you are |
13 |
| incapacitated , when you want this power to first take
effect . )
|
14 |
| (NOTE: If you do not amend or revoke this power, or if you do |
15 |
| not specify a specific ending date in paragraph 4, it will |
16 |
| remain in effect until your death; except that your agent will |
17 |
| still have the authority to donate your organs, authorize an |
18 |
| autopsy, and dispose of your remains after your death, if you |
19 |
| grant that authority to your agent.) |
20 |
| 4. ( ) This power of attorney shall terminate on
.......
|
21 |
| .............................................................
|
22 |
| ( NOTE: Insert insert a future date or event, such as a court |
23 |
| determination that you are not under a legal disability or a |
24 |
| written determination by your physician that you are not |
25 |
| incapacitated, if of your
disability, when you want this power |
26 |
| to terminate prior to your death . )
|
|
|
|
HB6477 Enrolled |
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LRB096 21113 AJO 36964 b |
|
|
1 |
| (NOTE: You cannot use this form to name co-agents. If you wish |
2 |
| to name successor agents, insert the names and addresses of the |
3 |
| successors in paragraph 5.) (IF YOU WISH TO NAME SUCCESSOR |
4 |
| AGENTS, INSERT THE NAMES AND ADDRESSES OF
SUCH SUCCESSORS IN |
5 |
| THE FOLLOWING PARAGRAPH.)
|
6 |
| 5. If any agent named by me shall die, become incompetent, |
7 |
| resign,
refuse to accept the office of agent or be unavailable, |
8 |
| I name
the following (each to act alone
and successively, in |
9 |
| the order named) as successors to such agent:
|
10 |
| .............................................................
|
11 |
| .............................................................
|
12 |
| For purposes of this paragraph 5, a person shall be considered |
13 |
| to be
incompetent if and while the person is a minor , or an |
14 |
| adjudicated
incompetent or disabled person , or the person is |
15 |
| unable to give prompt and
intelligent consideration to health |
16 |
| care matters, as certified by a licensed physician.
|
17 |
| (NOTE: If you wish to, you may name your agent as guardian of |
18 |
| your person if a court decides that one should be appointed. To |
19 |
| do this, retain paragraph 6, and the court will appoint your |
20 |
| agent if the court finds that this appointment will serve your |
21 |
| best interests and welfare. Strike out paragraph 6 if you do |
22 |
| not want your agent to act as guardian.) (IF YOU WISH TO NAME |
23 |
| YOUR AGENT AS GUARDIAN OF YOUR PERSON,
IN THE EVENT A COURT |
24 |
| DECIDES
THAT ONE SHOULD BE APPOINTED, YOU MAY, BUT ARE NOT |
25 |
| REQUIRED TO, DO SO BY
RETAINING THE FOLLOWING
PARAGRAPH. THE |
26 |
| COURT
WILL APPOINT YOUR AGENT IF THE COURT FINDS THAT SUCH
|
|
|
|
HB6477 Enrolled |
- 64 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| APPOINTMENT WILL SERVE YOUR BEST INTERESTS AND WELFARE. STRIKE |
2 |
| OUT
PARAGRAPH 6 IF YOU DO NOT WANT YOUR AGENT TO ACT AS |
3 |
| GUARDIAN.)
|
4 |
| 6. If a guardian of my person is to be appointed, I |
5 |
| nominate the agent
acting under this power of attorney as such
|
6 |
| guardian, to serve without bond or security.
|
7 |
| 7. I am fully informed as to all the contents of this form |
8 |
| and
understand the full import of this grant of powers to my |
9 |
| agent.
|
10 |
| Dated: ..........
|
11 |
| Signed ..............................
|
12 |
| (
principal's signature or mark
principal
)
|
13 |
| The principal has had an opportunity to review read the |
14 |
| above form and has
signed the form or acknowledged his or her |
15 |
| signature or mark on the form in my presence. The undersigned |
16 |
| witness certifies that the witness is not: (a) the attending |
17 |
| physician or mental health service provider or a relative of |
18 |
| the physician or provider; (b) an owner, operator, or relative |
19 |
| of an owner or operator of a health care facility in which the |
20 |
| principal is a patient or resident; (c) a parent, sibling, |
21 |
| descendant, or any spouse of such parent, sibling, or |
22 |
| descendant of either the principal or any agent or successor |
23 |
| agent under the foregoing power of attorney, whether such |
24 |
| relationship is by blood, marriage, or adoption; or (d) an |
25 |
| agent or successor agent under the foregoing power of attorney.
|
|
|
|
HB6477 Enrolled |
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LRB096 21113 AJO 36964 b |
|
|
1 |
| .......................
|
2 |
| (Witness Signature)
|
3 |
| .......................
|
4 |
| (Print Witness Name)
|
5 |
| .......................
|
6 |
| (Street Address)
|
7 |
| .......................
|
8 |
| (City, State, ZIP)
|
9 |
| .......................... Residing at......................
|
10 |
| (witness)
|
11 |
| (NOTE: You may, but are not required to, request your agent and |
12 |
| successor agents to provide specimen signatures below. If you |
13 |
| include specimen signatures in this power of attorney, you must |
14 |
| complete the certification opposite the signatures of the |
15 |
| agents.) (YOU MAY, BUT ARE NOT REQUIRED TO, REQUEST YOUR AGENT |
16 |
| AND SUCCESSOR AGENTS
TO PROVIDE SPECIMEN SIGNATURES BELOW. IF |
17 |
| YOU INCLUDE SPECIMEN SIGNATURES
IN THIS POWER OF ATTORNEY, YOU |
18 |
| MUST COMPLETE THE CERTIFICATION OPPOSITE THE
SIGNATURES OF THE |
19 |
| AGENTS.)
|
20 |
| Specimen signatures of I certify that the signatures of my
|
21 |
| agent (and successors). agent (and successors) are correct.
|
22 |
| ....................... ...................................
|
23 |
| (agent) (principal)
|
24 |
| ....................... ...................................
|
25 |
| (successor agent) (principal)
|
26 |
| ....................... ...................................
|
|
|
|
HB6477 Enrolled |
- 66 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| (successor agent) (principal)"
|
2 |
| (NOTE: The name, address, and phone number of the person |
3 |
| preparing this form or who assisted the principal in completing |
4 |
| this form is optional.) |
5 |
| .........................
|
6 |
| (name of preparer)
|
7 |
| .........................
|
8 |
| .........................
|
9 |
| (address)
|
10 |
| .........................
|
11 |
| (phone)
|
12 |
| (c) (b) The statutory short form power of attorney for |
13 |
| health care (the
"statutory health care power") authorizes the |
14 |
| agent to make any and all
health care decisions on behalf of |
15 |
| the principal which the principal could
make if present and |
16 |
| under no disability, subject to any limitations on the
granted |
17 |
| powers that appear on the face of the form, to be exercised in |
18 |
| such
manner as the agent deems consistent with the intent and |
19 |
| desires of the
principal. The agent will be under no duty to |
20 |
| exercise granted powers or
to assume control of or |
21 |
| responsibility for the principal's health care;
but when |
22 |
| granted powers are exercised, the agent will be required to use
|
23 |
| due care to act for the benefit of the principal in accordance |
24 |
| with the
terms of the statutory health care power and will be |
25 |
| liable
for negligent exercise. The agent may act in person or |
|
|
|
HB6477 Enrolled |
- 67 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| through others
reasonably employed by the agent for that |
2 |
| purpose
but may not delegate authority to make health care |
3 |
| decisions. The agent
may sign and deliver all instruments, |
4 |
| negotiate and enter into all
agreements and do all other acts |
5 |
| reasonably necessary to implement the
exercise of the powers |
6 |
| granted to the agent. Without limiting the
generality of the |
7 |
| foregoing, the statutory health care power shall include
the |
8 |
| following powers, subject to any limitations appearing on the |
9 |
| face of the form:
|
10 |
| (1) The agent is authorized to give consent to and |
11 |
| authorize or refuse,
or to withhold or withdraw consent to, |
12 |
| any and all types of medical care,
treatment or procedures |
13 |
| relating to the physical or mental health of the
principal, |
14 |
| including any medication program, surgical procedures,
|
15 |
| life-sustaining treatment or provision of food and fluids |
16 |
| for the principal.
|
17 |
| (2) The agent is authorized to admit the principal to |
18 |
| or discharge the
principal from any and all types of |
19 |
| hospitals, institutions, homes,
residential or nursing |
20 |
| facilities, treatment centers and other health care
|
21 |
| institutions providing personal care or treatment for any |
22 |
| type of physical
or mental condition. The agent shall have |
23 |
| the same right to visit the
principal in the hospital or |
24 |
| other institution as is granted to a spouse or
adult child |
25 |
| of the principal, any rule of the institution to the |
26 |
| contrary
notwithstanding.
|
|
|
|
HB6477 Enrolled |
- 68 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| (3) The agent is authorized to contract for any and all |
2 |
| types of health
care services and facilities in the name of |
3 |
| and on behalf of the principal
and to bind the principal to |
4 |
| pay for all such services and facilities,
and to have and |
5 |
| exercise those powers over the principal's property as are
|
6 |
| authorized under the statutory property power, to the |
7 |
| extent the agent
deems necessary to pay health care costs; |
8 |
| and
the agent shall not be personally liable for any |
9 |
| services or care contracted
for on behalf of the principal.
|
10 |
| (4) At the principal's expense and subject to |
11 |
| reasonable rules of the
health care provider to prevent |
12 |
| disruption of the principal's health care,
the agent shall |
13 |
| have the same right the principal has to examine and copy
|
14 |
| and consent to disclosure of all the principal's medical |
15 |
| records that the agent deems
relevant to the exercise of |
16 |
| the agent's powers, whether the records
relate to mental |
17 |
| health or any other medical condition and whether they are |
18 |
| in
the possession of or maintained by any physician, |
19 |
| psychiatrist,
psychologist, therapist, hospital, nursing |
20 |
| home or other health care
provider.
|
21 |
| (5) The agent is authorized: to direct that an autopsy |
22 |
| be made pursuant
to Section 2 of "An Act in relation to |
23 |
| autopsy of dead bodies", approved
August 13, 1965, |
24 |
| including all amendments;
to make a disposition of any
part |
25 |
| or all of the principal's body pursuant to the Illinois |
26 |
| Anatomical Gift
Act, as now or hereafter amended; and to |
|
|
|
HB6477 Enrolled |
- 69 - |
LRB096 21113 AJO 36964 b |
|
|
1 |
| direct the disposition of the
principal's remains.
|
2 |
| (Source: P.A. 93-794, eff. 7-22-04.)
|
3 |
| (755 ILCS 45/4-12) (from Ch. 110 1/2, par. 804-12)
|
4 |
| Sec. 4-12. Saving clause. This Act does not in any way
|
5 |
| invalidate any health care agency executed or any act of any
|
6 |
| agent done, or affect any claim, right or
remedy that accrued, |
7 |
| prior to September 22, 1987.
|
8 |
| This amendatory Act of the 96th General Assembly does not |
9 |
| in any way invalidate any health care agency executed or any |
10 |
| act of any agent done, or affect any claim, right, or remedy |
11 |
| that accrued, prior to the effective date of this amendatory |
12 |
| Act of the 96th General Assembly. |
13 |
| (Source: P.A. 86-736.)
|
14 |
| (755 ILCS 45/2-7.5 rep.) |
15 |
| Section 10. The Illinois Power of Attorney Act is amended |
16 |
| by repealing Section 2-7.5. |
17 |
| Section 99. Effective date. This Act takes effect July 1, |
18 |
| 2011. |