Full Text of HB6477 96th General Assembly
HB6477ham001 96TH GENERAL ASSEMBLY
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Rep. Emily McAsey
Filed: 3/17/2010
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| AMENDMENT TO HOUSE BILL 6477
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| AMENDMENT NO. ______. Amend House Bill 6477 by replacing | 3 |
| everything after the enacting clause with the following:
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| "Section 5. The Illinois Power of Attorney Act is amended | 5 |
| by changing Sections 2-1, 2-3, 2-5, 2-7, 2-8, 2-10, 2-11, 3-3, | 6 |
| 3-4, 4-4, 4-10, and 4-12 and by adding Sections 2-10.3, 2-10.5, | 7 |
| 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 | 10 |
| each
individual has the right to appoint an agent to make deal | 11 |
| with property , financial, or make
personal , and health care | 12 |
| decisions for the individual but that this right
cannot be | 13 |
| fully effective unless the principal may empower the agent to | 14 |
| act
throughout the principal's lifetime, including during | 15 |
| periods of
disability, and have confidence be sure that third | 16 |
| parties will honor the agent's authority
at all times.
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| The General Assembly finds that in the light of modern | 2 |
| financial needs
and advances in medical science, the statutory | 3 |
| recognition of this right of
delegation in Illinois needs to be | 4 |
| restated , which will to , among other things, expand the
its | 5 |
| application and the permissible scope of the agent's authority, | 6 |
| clarify
the power of the individual to authorize an agent to | 7 |
| make financial and
care decisions for the individual and better | 8 |
| protect health care personnel
and other third parties who rely | 9 |
| in good faith on the agent so that
reliance will be assured. | 10 |
| Nothing in this Act shall be deemed to
authorize or encourage | 11 |
| euthanasia, suicide or any action or course of
action that | 12 |
| 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 | 14 |
| encourage
any violation of a civil right expressed in the | 15 |
| Constitution, statutes,
case law and administrative rulings of | 16 |
| this State (including, without
limitation, the right of | 17 |
| conscience respected and protected by the Health
Care Right of | 18 |
| Conscience Act, as now or hereafter amended) or the
United | 19 |
| States or any action or course of action that violates the | 20 |
| public policy
expressed in the Constitution, statutes, case law | 21 |
| 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 | 2 |
| principal and agent or the
relationship, itself, as appropriate | 3 |
| to the context, and includes agencies
dealing with personal or | 4 |
| health care as well as property. An agency is
subject to this | 5 |
| 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 | 8 |
| designated to act
for the principal in the agency.
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| (c) "Disabled person" has the same meaning as in the | 10 |
| "Probate Act of
1975", as now or hereafter amended. To be under | 11 |
| a "disability" or
"disabled" means to be a disabled person.
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| (c-5) "Incapacitated", when used to describe a principal, | 13 |
| means that the principal is under a legal disability as defined | 14 |
| in Section 11a-2 of the Probate Act of 1975. A principal shall | 15 |
| also be considered incapacitated if: (i) a physician licensed | 16 |
| to practice medicine in all of its branches has examined the | 17 |
| principal and has determined that the principal lacks decision | 18 |
| making capacity; (ii) that physician has made a written record | 19 |
| of this determination and has signed the written record within | 20 |
| 90 days after the examination; and (iii) the written record has | 21 |
| been delivered to the agent. The agent may rely conclusively on | 22 |
| the written record. | 23 |
| (d) "Person" means an individual, corporation, trust, | 24 |
| partnership or
other entity, as appropriate to the agency.
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| (e) "Principal" means an individual (including, without | 26 |
| limitation, an
individual acting as trustee, representative or |
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| other fiduciary) who signs
a power of attorney or other | 2 |
| 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. | 6 |
| Unless the
agency states an earlier termination date, the | 7 |
| agency continues until the
death of the principal, | 8 |
| notwithstanding any lapse of time, the principal's
disability | 9 |
| 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 | 11 |
| revoked by the
principal , if the principal has the capacity to | 12 |
| do so, at any time and in any manner communicated to the agent | 13 |
| or to any
other person related to the subject matter of the | 14 |
| agency, except that
revocation and amendment of health care | 15 |
| agencies are governed by Section 4-6
of this Act except to the | 16 |
| extent the terms of the agencies are inconsistent
with that | 17 |
| Section. The execution of a power of attorney does not revoke a | 18 |
| power of attorney previously executed by the principal unless | 19 |
| the subsequent power of attorney provides that the previous | 20 |
| power of attorney is revoked or that all other powers of | 21 |
| 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. | 2 |
| (a) The agent shall be under
no duty to exercise the powers | 3 |
| granted by the agency or to assume control
of or responsibility | 4 |
| for any of the principal's property, care or affairs,
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| regardless of the principal's physical or mental condition. | 6 |
| Whenever a
power is exercised, the agent shall use due care to | 7 |
| act in good faith for the benefit of
the principal using due | 8 |
| care, competence, and diligence in accordance with the terms of | 9 |
| the agency and shall be
liable for negligent exercise. An agent | 10 |
| who acts with due care for the
benefit of the principal shall | 11 |
| not be liable or limited merely because the
agent also benefits | 12 |
| from the act, has individual or conflicting interests
in | 13 |
| relation to the property, care or affairs of the principal or | 14 |
| acts in a
different manner with respect to the agency and the | 15 |
| agent's individual
interests. The agent shall keep a record of | 16 |
| all receipts, disbursements,
and significant actions taken | 17 |
| under the agency.
The agent shall not be
affected by any | 18 |
| amendment or termination
of the agency until the agent has | 19 |
| actual knowledge thereof. The agent
shall not be liable for any | 20 |
| loss due to error of judgment nor for the act
or default of any | 21 |
| other person.
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| (b) An agent that has accepted appointment must act in | 23 |
| accordance with the principal's expectations to the extent | 24 |
| actually known to the agent and otherwise in the principal's | 25 |
| best interests. | 26 |
| (c) An agent shall keep a record of all receipts, |
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| disbursements, and significant actions taken under the | 2 |
| authority of the agency and shall provide a copy of this record | 3 |
| when requested to do so by: | 4 |
| (1) the principal, a guardian, another fiduciary | 5 |
| acting on behalf of the principal, and, after the death of | 6 |
| the principal, the personal representative or successors | 7 |
| in interest of the principal's estate; | 8 |
| (2) a representative of a provider agency, as defined | 9 |
| in Section 2 of the Elder Abuse and Neglect Act, acting in | 10 |
| the course of an assessment of a complaint of elder abuse | 11 |
| or neglect under that Act; | 12 |
| (3) a representative of the Office of the State Long | 13 |
| Term Care Ombudsman, acting in the course of an | 14 |
| investigation of a complaint of financial exploitation of a | 15 |
| nursing home resident under Section 4.04 of the Illinois | 16 |
| Act on the Aging; | 17 |
| (4) a representative of the Office of Inspector General | 18 |
| for the Department of Human Services, acting in the course | 19 |
| of an assessment of a complaint of financial exploitation | 20 |
| of an adult with disabilities pursuant to Section 35 of the | 21 |
| Abuse of Adults with Disabilities Intervention Act; or | 22 |
| (5) a court under Section 2-10 of this Act. | 23 |
| (d) If the agent fails to provide his or her record of all | 24 |
| receipts, disbursements, and significant actions within 21 | 25 |
| days after a request under subsection (c), the elder abuse | 26 |
| 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 | 2 |
| his or her record of receipts, disbursements, and significant | 3 |
| actions. If the court finds that the agent's failure to provide | 4 |
| his or her record in a timely manner to the elder abuse | 5 |
| provider agency or the State Long Term Care Ombudsman was | 6 |
| without good cause, the court may assess reasonable costs and | 7 |
| attorney's fees against the agent, and order such other relief | 8 |
| as is appropriate. | 9 |
| (e) An agent is not required to disclose receipts, | 10 |
| disbursements, or other significant actions conducted on | 11 |
| behalf of the principal except as otherwise provided in the | 12 |
| power of attorney or as required under subsection (c). | 13 |
| (f) An agent that violates this Act is liable to the | 14 |
| principal or the principal's successors in interest for the | 15 |
| amount required (i) to restore the value of the principal's | 16 |
| property to what it would have been had the violation not | 17 |
| occurred, and (ii) to reimburse the principal or the | 18 |
| principal's successors in interest for the attorney's fees and | 19 |
| costs paid on the agent's behalf. This subsection does not | 20 |
| limit any other applicable legal or equitable remedies. | 21 |
| (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. | 25 |
| (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 | 2 |
| protected and
released to
the same extent as though the reliant | 3 |
| had dealt directly with the
named
principal
as a | 4 |
| fully-competent person. The
named
agent shall furnish an | 5 |
| affidavit or Agent's Certification and Acceptance of Authority | 6 |
| to the
reliant on demand stating that the instrument relied on | 7 |
| is a true copy of
the agency and that, to the best of the
named
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| agent's knowledge, the named principal is
alive and the | 9 |
| 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 | 11 |
| establish an agency will protect the reliant
without the | 12 |
| affidavit or Agent's Certification and Acceptance of | 13 |
| Authority . | 14 |
| (b) Upon request, the named agent in a power of attorney | 15 |
| shall furnish an Agent's Certification and Acceptance of | 16 |
| Authority to the reliant in substantially the following form: | 17 |
| AGENT'S CERTIFICATION AND ACCEPTANCE OF AUTHORITY | 18 |
| I, .......... (insert name of agent), certify that the | 19 |
| attached is a true copy of a power of attorney naming the | 20 |
| undersigned as agent or successor agent for ............. | 21 |
| (insert name of principal). | 22 |
| I certify that to the best of my knowledge the principal | 23 |
| had the capacity to execute the power of attorney, is alive, | 24 |
| 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 | 2 |
| of attorney remains in full force and effect. | 3 |
| I accept appointment as agent under this power of attorney. | 4 |
| This certification and acceptance is made under penalty of | 5 |
| perjury.* | 6 |
| Dated: ............ | 7 |
| .......................
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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 | 14 |
| Code of 1961, and is a Class 3 felony.) | 15 |
| (c) Any person dealing with an agent
named in a copy of a | 16 |
| document purporting to establish an agency
may presume, in
the | 17 |
| absence of actual knowledge to the contrary, that the
document | 18 |
| purporting to establish the
agency was
validly executed,
that | 19 |
| the agency was validly established,
that the named principal | 20 |
| was competent at the time
of execution, and that, at the time | 21 |
| of reliance, the
named
principal is alive,
the agency
was | 22 |
| validly established
and has not terminated or been amended, the | 23 |
| relevant powers of the
named
agent were properly and validly | 24 |
| granted and have not terminated or
been amended, and the acts | 25 |
| 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 | 2 |
| an agency shall be required to see to the application
of any | 3 |
| property delivered to or controlled by the
named
agent or to | 4 |
| question the
authority of the
named
agent. | 5 |
| (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 | 7 |
| purporting to establish an
agency is communicated shall comply | 8 |
| with
that direction, and any person who fails to comply | 9 |
| arbitrarily or without
reasonable cause shall be subject to | 10 |
| civil liability for any damages
resulting from noncompliance.
A | 11 |
| 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. | 16 |
| (a) Upon petition by any interested
person (including the | 17 |
| agent), with such notice to interested persons as the
court | 18 |
| directs and a finding by the court that the principal
lacks | 19 |
| either the capacity to control or the capacity to revoke the | 20 |
| agency , the court may construe a power of attorney, review the | 21 |
| agent's conduct, and grant appropriate relief including | 22 |
| compensatory damages. : (a) if | 23 |
| (b) If the court finds
that the agent is not acting for the | 24 |
| benefit of the principal in accordance
with the terms of the | 25 |
| 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 | 2 |
| property
in a manner not authorized or intended by the | 3 |
| principal, the court may
order a guardian of the principal's | 4 |
| person or estate to exercise any powers
of the principal under | 5 |
| the agency, including the power to revoke the
agency, or may | 6 |
| 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 | 8 |
| the
principal . | 9 |
| (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 | 11 |
| the agent,
but the court may not amend the agency. | 12 |
| (d) If the court finds that the agent has not acted for the | 13 |
| benefit of the principal in accordance with the terms of the | 14 |
| agency and the Illinois Power of Attorney Act, or that the | 15 |
| agent's action caused or threatened substantial harm to the | 16 |
| principal's person or property in a manner not authorized or | 17 |
| intended by the principal, then the agent shall not be | 18 |
| authorized to pay or be reimbursed from the estate of the | 19 |
| principal the attorneys' fees and costs of the agent in | 20 |
| defending a proceeding brought pursuant to this Section. | 21 |
| (e) Upon a finding that the agent's action has caused | 22 |
| substantial harm to the principal's person or property, the | 23 |
| court may assess against the agent reasonable costs and | 24 |
| attorney's fees to a prevailing party who is a provider agency | 25 |
| as defined in Section 2 of the Elder Abuse and Neglect Act, a | 26 |
| representative of the Office of the State Long Term Care |
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| Ombudsman, or a governmental agency having regulatory | 2 |
| authority to protect the welfare of the principal. | 3 |
| (f) As used in this Section, the term "interested person" | 4 |
| includes (1) the principal or the agent; (2) a guardian of the | 5 |
| person, guardian of the estate, or other fiduciary charged with | 6 |
| management of the principal's property; (3) the principal's | 7 |
| spouse, parent, or descendant; (4) a person who would be a | 8 |
| presumptive heir-at-law of the principal; (5) a person named as | 9 |
| a beneficiary to receive any property, benefit, or contractual | 10 |
| right upon the principal's death, or as a beneficiary of a | 11 |
| trust created by or for the principal; (6) a provider agency as | 12 |
| defined in Section 2 of the Elder Abuse and Neglect Act, a | 13 |
| representative of the Office of the State Long Term Care | 14 |
| Ombudsman, or a governmental agency having regulatory | 15 |
| authority to protect the welfare of the principal; and (7) the | 16 |
| principal's caregiver or another person who demonstrates | 17 |
| sufficient interest in the principal's welfare. | 18 |
| (g) Absent court order directing a
guardian to exercise | 19 |
| powers of the principal under the agency, a guardian
will have | 20 |
| no power, duty or liability with respect to any property | 21 |
| subject
to the agency or any personal or health care matters | 22 |
| covered by the agency. | 23 |
| (h)
Proceedings under this Section shall be commenced in | 24 |
| the county where the
guardian was appointed or, if no Illinois | 25 |
| guardian is acting, then in the
county where the agent or | 26 |
| 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 | 3 |
| remedies available. | 4 |
| (Source: P.A. 85-701.)
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| (755 ILCS 45/2-10.3 new) | 6 |
| Sec. 2-10.3. Successor agents. | 7 |
| (a) A principal may designate one or more successor agents | 8 |
| to act if an initial or predecessor agent resigns, dies, | 9 |
| becomes incapacitated, is not qualified to serve, or declines | 10 |
| to serve. A principal may grant authority to another person, | 11 |
| designated by name, by office, or by function, including an | 12 |
| initial or successor agent, to designate one or more successor | 13 |
| agents. Unless a power of attorney otherwise provides, a | 14 |
| successor agent has the same authority as that granted to an | 15 |
| initial agent. | 16 |
| (b) An agent is not liable for the actions of another | 17 |
| agent, including a predecessor agent, unless the agent | 18 |
| participates in or conceals a breach of fiduciary duty | 19 |
| committed by the other agent. An agent who has knowledge of a | 20 |
| breach or imminent breach of fiduciary duty by another agent | 21 |
| must notify the principal and, if the principal is | 22 |
| incapacitated, take whatever actions may be reasonably | 23 |
| appropriate in the circumstances to safeguard the principal's | 24 |
| best interest. | 25 |
| (c) Any person who acts in good faith reliance on the |
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| representation of a successor agent regarding the | 2 |
| unavailability of a predecessor agent will be fully protected | 3 |
| and released to the same extent as though the reliant had dealt | 4 |
| directly with the predecessor agent. Upon request, the | 5 |
| successor agent shall furnish an affidavit or Successor Agent's | 6 |
| Certification and Acceptance of Authority to the reliant, but | 7 |
| good faith reliance on a document purporting to establish an | 8 |
| agency will protect the reliant without the affidavit or | 9 |
| Successor Agent's Certification and Acceptance of Authority. A | 10 |
| Successor Agent's Certification and Acceptance of Authority | 11 |
| shall be in substantially the following form: | 12 |
| SUCCESSOR AGENT'S | 13 |
| CERTIFICATION AND ACCEPTANCE OF AUTHORITY | 14 |
| I certify that the attached is a true copy of a power of | 15 |
| attorney naming the undersigned as agent or successor agent for | 16 |
| .......... (insert name of principal). | 17 |
| I certify that to the best of my knowledge the principal | 18 |
| had the capacity to execute the power of attorney, is alive, | 19 |
| and has not revoked the power of attorney; that my powers as | 20 |
| agent have not been altered or terminated; and that the power | 21 |
| of attorney remains in full force and effect. | 22 |
| I certify that to the best of my knowledge .......... | 23 |
| (insert name of unavailable agent) is unavailable due to | 24 |
| ................. (specify death, resignation, absence, |
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| illness, or other temporary incapacity). | 2 |
| I accept appointment as agent under this power of attorney. | 3 |
| This certification and acceptance is made under penalty of | 4 |
| perjury.* | 5 |
| Dated: ............ | 6 |
| .......................
| 7 |
| (Agent's Signature)
| 8 |
| .......................
| 9 |
| (Print Agent's Name)
| 10 |
| .......................
| 11 |
| (Agent's Address)
| 12 |
| *(NOTE: Perjury is defined in Section 32-2 of the Criminal | 13 |
| Code of 1961, and is a Class 3 felony.) | 14 |
| (755 ILCS 45/2-10.5 new)
| 15 |
| Sec. 2-10.5. Co-agents. | 16 |
| (a) Co-agents may not be named by a principal in a | 17 |
| statutory short form power of attorney for property under | 18 |
| Article III or a statutory short form power of attorney for | 19 |
| health care under Article IV. In the event that co-agents are | 20 |
| named in any other form of power of attorney, then the | 21 |
| provisions of this Section shall govern the use and acceptance | 22 |
| of co-agency designations. | 23 |
| (b) Unless the power of attorney or this Section otherwise | 24 |
| provides, authority granted to 2 or more co-agents is | 25 |
| exercisable only by their majority consent. However, if prompt |
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| action is required to accomplish the purposes of the power of | 2 |
| attorney or to avoid irreparable injury to the principal's | 3 |
| interests and an agent is unavailable because of absence, | 4 |
| illness, or other temporary incapacity, the other agent or | 5 |
| agents may act for the principal. If a vacancy occurs in one or | 6 |
| more of the designations of agent under a power of attorney, | 7 |
| the remaining agent or agents may act for the principal. | 8 |
| (c) An agent is not liable for the actions of another | 9 |
| agent, including a co-agent or predecessor agent, unless the | 10 |
| agent participates in or conceals a breach of fiduciary duty | 11 |
| committed by the other agent. An agent who has knowledge of a | 12 |
| breach or imminent breach of fiduciary duty by another agent | 13 |
| must notify the principal and, if the principal is | 14 |
| incapacitated, take whatever actions may be reasonably | 15 |
| appropriate in the circumstances to safeguard the principal's | 16 |
| best interest. | 17 |
| (d) Any person who acts in good faith reliance on the | 18 |
| representation of a co-agent regarding the unavailability of a | 19 |
| predecessor agent or one or more co-agents, or the need for | 20 |
| prompt action to accomplish the purposes of the power of | 21 |
| attorney or to avoid irreparable injury to the principal's | 22 |
| interests, will be fully protected and released to the same | 23 |
| extent as though the reliant had dealt directly with all named | 24 |
| agents. Upon request, the co-agent shall furnish an affidavit | 25 |
| or Co-Agent's Certification and Acceptance of Authority to the | 26 |
| reliant, but good faith reliance on a document purporting to |
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| establish an agency will protect the reliant without the | 2 |
| affidavit or Co-Agent's Certification and Acceptance of | 3 |
| Authority. A Co-Agent's Certification and Acceptance of | 4 |
| Authority shall be in substantially the following form: | 5 |
| CO-AGENT'S | 6 |
| CERTIFICATION AND ACCEPTANCE OF AUTHORITY | 7 |
| I certify that the attached is a true copy of a power of | 8 |
| attorney naming the undersigned as agent or co-agent for | 9 |
| .......... (insert name of principal). | 10 |
| I certify that to the best of my knowledge the principal | 11 |
| had the capacity to execute the power of attorney, is alive, | 12 |
| and has not revoked the power of attorney; that my powers as | 13 |
| agent have not been altered or terminated; and that the power | 14 |
| of attorney remains in full force and effect. | 15 |
| I certify that to the best of my knowledge .......... | 16 |
| (insert name of unavailable agent) is unavailable due to | 17 |
| ................. (specify death, resignation, absence, | 18 |
| illness, or other temporary incapacity). | 19 |
| I certify that prompt action is required to accomplish the | 20 |
| purposes of the power of attorney or to avoid irreparable | 21 |
| injury to the principal's interests. | 22 |
| I accept appointment as agent under this power of attorney. | 23 |
| This certification and acceptance is made under penalty of | 24 |
| perjury.* |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| Dated: ............ | 2 |
| .......................
| 3 |
| (Agent's Signature)
| 4 |
| .......................
| 5 |
| (Print Agent's Name)
| 6 |
| .......................
| 7 |
| (Agent's Address)
| 8 |
| *(NOTE: Perjury is defined in Section 32-2 of the Criminal | 9 |
| Code of 1961, and is a Class 3 felony.) | 10 |
| (755 ILCS 45/2-10.6 new)
| 11 |
| Sec. 2-10.6. Power of attorney executed in another state or | 12 |
| country; pre-existing powers of attorney. | 13 |
| (a) A power of attorney executed in another state or | 14 |
| country is valid and enforceable in this State if its creation | 15 |
| complied when executed with: | 16 |
| (1) the law of the state or country in which the power | 17 |
| of attorney was executed; | 18 |
| (2) the law of this State; | 19 |
| (3) the law of the state or country where the principal | 20 |
| is domiciled, has a place of abode or business, or is a | 21 |
| national; or | 22 |
| (4) the law of the state or country where the agent is | 23 |
| domiciled or has a place of business. | 24 |
| (b) A power of attorney executed in this State before the | 25 |
| effective date of this amendatory Act of the 96th General |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| Assembly is valid and enforceable in this State if its creation | 2 |
| complied with the law of this State as it existed at the time | 3 |
| of execution.
| 4 |
| (755 ILCS 45/2-11) (from Ch. 110 1/2, par. 802-11)
| 5 |
| Sec. 2-11. Saving clause. This Act does not in any way
| 6 |
| invalidate any agency executed or any act of any agent done, or
| 7 |
| affect any claim, right or remedy that accrued, prior to
| 8 |
| September 22, 1987.
| 9 |
| This amendatory Act of the 96th General Assembly does not | 10 |
| in any way invalidate any agency executed or any act of any | 11 |
| agent done, or affect any claim, right, or remedy that accrued | 12 |
| prior to the effective date of this amendatory Act of the 96th | 13 |
| General Assembly. | 14 |
| (Source: P.A. 86-736.)
| 15 |
| (755 ILCS 45/3-3) (from Ch. 110 1/2, par. 803-3)
| 16 |
| Sec. 3-3. Statutory short form power of attorney for | 17 |
| property. | 18 |
| (a) The
following form prescribed in this Section may be | 19 |
| known as "statutory property power" and may be used
to grant an | 20 |
| agent powers with respect to property and financial matters.
| 21 |
| The "statutory property power" consists of the following: (1) | 22 |
| Notice to the Individual Signing the Illinois Statutory Short | 23 |
| Form Power of Attorney for Property; (2) Illinois Statutory | 24 |
| Short Form Power of Attorney for Property; and (3) Notice to |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| Agent. When a power of attorney in substantially the following | 2 |
| form prescribed in this Section is used,
including all 3 items | 3 |
| above, with item (1), the Notice to Individual Signing the | 4 |
| Illinois Statutory Short Form Power of Attorney for Property, | 5 |
| on a separate sheet (coversheet) in 14-point type the "notice" | 6 |
| paragraph at the beginning in capital letters and
the notarized | 7 |
| form of acknowledgment at the end, it shall have the meaning
| 8 |
| and effect prescribed in this Act. | 9 |
| (b) A power of attorney shall also be deemed to be in | 10 |
| substantially the same format as the statutory form if the | 11 |
| explanatory language throughout the form (the language | 12 |
| following the designation "NOTE:") is distinguished in some way | 13 |
| from the legal paragraphs in the form, such as the use of | 14 |
| boldface or other difference in typeface and font or point | 15 |
| size, even if the "Notice" paragraphs at the beginning are not | 16 |
| on a separate sheet of paper or are not in 14-point type, or if | 17 |
| the principal's initials do not appear in the acknowledgement | 18 |
| at the end of the "Notice" paragraphs. | 19 |
| The validity of a power of attorney as
meeting the | 20 |
| requirements of a statutory property power shall not be
| 21 |
| affected by the fact that one or more of the categories of | 22 |
| optional powers
listed in the form are struck out or the form | 23 |
| includes specific
limitations on or additions to the agent's | 24 |
| powers, as permitted by the
form. Nothing in this Article shall | 25 |
| invalidate or bar use by the
principal of any other or | 26 |
| different form of power of attorney for property.
Nonstatutory |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| property powers (i) must be executed by the principal , (ii) | 2 |
| must and
designate the agent and the agent's powers , (iii) must | 3 |
| be signed by at least one witness to the principal's signature, | 4 |
| and (iv) must indicate that the principal has acknowledged his | 5 |
| or her signature before a notary public. However, nonstatutory | 6 |
| property powers , but they need not be acknowledged
or
conform | 7 |
| in any other respect to the statutory property power.
| 8 |
| (c) The Notice to the Individual Signing the Illinois | 9 |
| Statutory Short Form Power of Attorney for Property shall be | 10 |
| substantially as follows: | 11 |
| "NOTICE TO THE INDIVIDUAL SIGNING THE ILLINOIS | 12 |
| STATUTORY SHORT FORM POWER OF ATTORNEY FOR PROPERTY. | 13 |
| PLEASE READ THIS NOTICE CAREFULLY. The form that you will | 14 |
| be signing is a legal document. It is governed by the Illinois | 15 |
| Power of Attorney Act. If there is anything about this form | 16 |
| that you do not understand, you should ask a lawyer to explain | 17 |
| it to you. | 18 |
| The purpose of this Power of Attorney is to give your | 19 |
| designated "agent" broad powers to handle your financial | 20 |
| affairs, which may include the power to pledge, sell, or | 21 |
| dispose of any of your real or personal property, even without | 22 |
| your consent or any advance notice to you. When using the | 23 |
| Statutory Short Form, you may name successor agents, but you | 24 |
| may not name co-agents. |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| This form does not impose a duty upon your agent to handle | 2 |
| your financial affairs, so it is important that you select an | 3 |
| agent who will agree to do this for you. It is also important | 4 |
| to select an agent whom you trust, since you are giving that | 5 |
| agent control over your financial assets and property. Any | 6 |
| agent who does act for you has a duty to act in good faith for | 7 |
| your benefit and to use due care, competence, and diligence. He | 8 |
| or she must also act in accordance with the law and with the | 9 |
| directions in this form. Your agent must keep a record of all | 10 |
| receipts, disbursements, and significant actions taken as your | 11 |
| agent. | 12 |
| Unless you specifically limit the period of time that this | 13 |
| Power of Attorney will be in effect, your agent may exercise | 14 |
| the powers given to him or her throughout your lifetime, both | 15 |
| before and after you become incapacitated. A court, however, | 16 |
| can take away the powers of your agent if it finds that the | 17 |
| agent is not acting properly. You may also revoke this Power of | 18 |
| Attorney if you wish. | 19 |
| This Power
of Attorney does not authorize your agent to | 20 |
| appear in court for you as an attorney-at-law or otherwise to | 21 |
| engage in the practice of law unless he or she is a licensed | 22 |
| attorney who is authorized to practice law in Illinois. | 23 |
| The powers you give your agent are explained more fully in | 24 |
| Section 3-4 of the Illinois Power of Attorney Act. This form is | 25 |
| a part of that law. The "NOTE" paragraphs throughout this form | 26 |
| are instructions. |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 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 this Power of Attorney if you do not understand everything | 4 |
| in it, and what your agent will be able to do if you do sign it. | 5 |
| Please place your initials on the following line indicating | 6 |
| that you have read this Notice: | 7 |
| .....................
| 8 |
| Principal's initials"
| 9 |
| (d) The Illinois Statutory Short Form Power of Attorney for | 10 |
| Property shall be substantially as follows: | 11 |
| "ILLINOIS STATUTORY SHORT FORM | 12 |
| POWER OF ATTORNEY FOR PROPERTY
| 13 |
| (NOTICE: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE | 14 |
| THE PERSON YOU
DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE | 15 |
| YOUR PROPERTY, WHICH MAY
INCLUDE POWERS TO PLEDGE, SELL OR | 16 |
| OTHERWISE DISPOSE OF ANY REAL OR PERSONAL
PROPERTY WITHOUT | 17 |
| ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THIS FORM DOES
NOT | 18 |
| IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS; BUT | 19 |
| WHEN POWERS
ARE EXERCISED, YOUR AGENT WILL HAVE TO USE DUE CARE | 20 |
| TO ACT FOR YOUR
BENEFIT AND IN ACCORDANCE WITH THIS FORM AND | 21 |
| KEEP A RECORD OF RECEIPTS,
DISBURSEMENTS AND SIGNIFICANT | 22 |
| ACTIONS TAKEN AS AGENT. A COURT CAN TAKE AWAY THE POWERS
OF |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| YOUR AGENT IF IT FINDS THE AGENT IS NOT ACTING PROPERLY. YOU | 2 |
| MAY NAME
SUCCESSOR AGENTS UNDER THIS FORM BUT NOT CO-AGENTS. | 3 |
| UNLESS YOU EXPRESSLY
LIMIT THE DURATION OF THIS POWER IN THE | 4 |
| MANNER PROVIDED BELOW, UNTIL YOU
REVOKE THIS POWER OR A COURT | 5 |
| ACTING ON YOUR BEHALF TERMINATES IT, YOUR
AGENT MAY EXERCISE | 6 |
| THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN
AFTER YOU | 7 |
| BECOME DISABLED. THE POWERS YOU GIVE YOUR AGENT ARE EXPLAINED
| 8 |
| MORE FULLY IN SECTION 3-4 OF THE ILLINOIS "STATUTORY SHORT FORM | 9 |
| POWER OF
ATTORNEY FOR PROPERTY LAW" OF WHICH THIS FORM IS A | 10 |
| PART
(SEE THE BACK OF THIS FORM). THAT LAW EXPRESSLY PERMITS | 11 |
| THE USE OF ANY
DIFFERENT FORM OF POWER OF ATTORNEY YOU MAY | 12 |
| DESIRE. IF THERE IS ANYTHING
ABOUT THIS FORM THAT YOU DO NOT | 13 |
| UNDERSTAND, YOU SHOULD ASK A LAWYER TO EXPLAIN
IT TO YOU.)
| 14 |
| POWER OF ATTORNEY made this .... day of ....... (month) | 15 |
| ...... (year)
| 16 |
| 1. I, ..............., (insert name and address of | 17 |
| principal)
hereby revoke all prior powers of attorney for | 18 |
| property executed by me and appoint:
| 19 |
| .............................................................
| 20 |
| (insert name and address of agent)
| 21 |
| (NOTE: You may not name co-agents using this form.) | 22 |
| as my attorney-in-fact (my "agent") to act for me and in my | 23 |
| name (in any
way I could act in person) with respect to the | 24 |
| following powers, as defined
in Section 3-4 of the "Statutory | 25 |
| Short Form Power of Attorney for Property Law"
(including all | 26 |
| amendments), but subject to any limitations on or additions
to |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| the specified powers inserted in paragraph 2 or 3 below:
| 2 |
| (NOTE: You must strike out any one or more of the following | 3 |
| categories of
powers you do not want your agent to have. | 4 |
| Failure to strike the title
of any category will cause the | 5 |
| powers described in that category to be
granted to the agent. | 6 |
| To strike out a category you must draw a line
through the title | 7 |
| of that category.) (YOU MUST STRIKE OUT ANY ONE OR MORE OF THE | 8 |
| FOLLOWING CATEGORIES OF
POWERS YOU DO NOT WANT YOUR AGENT TO | 9 |
| HAVE. FAILURE TO STRIKE THE TITLE
OF ANY CATEGORY WILL CAUSE | 10 |
| THE POWERS DESCRIBED IN THAT CATEGORY TO BE
GRANTED TO THE | 11 |
| AGENT. TO STRIKE OUT A CATEGORY YOU MUST DRAW A LINE
THROUGH | 12 |
| THE TITLE OF THAT CATEGORY.)
| 13 |
| (a) Real estate transactions.
| 14 |
| (b) Financial institution transactions.
| 15 |
| (c) Stock and bond transactions.
| 16 |
| (d) Tangible personal property transactions.
| 17 |
| (e) Safe deposit box transactions.
| 18 |
| (f) Insurance and annuity transactions.
| 19 |
| (g) Retirement plan transactions.
| 20 |
| (h) Social Security, employment and military service | 21 |
| benefits.
| 22 |
| (i) Tax matters.
| 23 |
| (j) Claims and litigation.
| 24 |
| (k) Commodity and option transactions.
| 25 |
| (l) Business operations.
|
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| (m) Borrowing transactions.
| 2 |
| (n) Estate transactions.
| 3 |
| (o) All other property powers and transactions.
| 4 |
| (NOTE: Limitations on and additions to the agent's powers may | 5 |
| be included in this power of attorney if they are specifically | 6 |
| described below.) (LIMITATIONS ON AND ADDITIONS TO THE AGENT'S | 7 |
| POWERS MAY BE INCLUDED IN THIS
POWER OF ATTORNEY IF THEY ARE | 8 |
| SPECIFICALLY DESCRIBED BELOW.)
| 9 |
| 2. The powers granted above shall not include the following | 10 |
| powers or
shall be modified or limited in the following | 11 |
| particulars : | 12 |
| ( NOTE: Here here you may
include any specific limitations you | 13 |
| deem appropriate, such as a
prohibition or conditions on the | 14 |
| sale of particular stock or real estate or
special rules on | 15 |
| borrowing by the agent . ) :
| 16 |
| .............................................................
| 17 |
| .............................................................
| 18 |
| .............................................................
| 19 |
| .............................................................
| 20 |
| .............................................................
| 21 |
| 3. In addition to the powers granted above, I grant my | 22 |
| agent the
following powers : | 23 |
| ( NOTE: Here here you may add any other delegable powers | 24 |
| including,
without limitation, power to make gifts, exercise | 25 |
| powers of appointment,
name or change beneficiaries or joint | 26 |
| tenants or revoke or amend any trust
specifically referred to |
|
|
|
09600HB6477ham001 |
- 27 - |
LRB096 21113 AJO 39174 a |
|
| 1 |
| below . ) :
| 2 |
| .............................................................
| 3 |
| .............................................................
| 4 |
| .............................................................
| 5 |
| .............................................................
| 6 |
| .............................................................
| 7 |
| (NOTE: Your agent will have authority to employ other persons | 8 |
| as necessary to enable the agent to properly exercise the | 9 |
| powers granted in this form, but your agent will have to make | 10 |
| all discretionary decisions. If you want to give your agent the | 11 |
| right to delegate discretionary decision-making powers to | 12 |
| others, you should keep paragraph 4, otherwise it should be | 13 |
| struck out.) (YOUR AGENT WILL HAVE AUTHORITY TO EMPLOY OTHER | 14 |
| PERSONS AS NECESSARY TO
ENABLE THE AGENT TO PROPERLY EXERCISE | 15 |
| THE POWERS GRANTED IN THIS FORM, BUT
YOUR AGENT WILL HAVE TO | 16 |
| MAKE ALL DISCRETIONARY DECISIONS. IF YOU WANT TO
GIVE YOUR | 17 |
| AGENT THE RIGHT TO DELEGATE DISCRETIONARY DECISION-MAKING | 18 |
| POWERS
TO OTHERS, YOU SHOULD KEEP THE NEXT SENTENCE, OTHERWISE | 19 |
| IT SHOULD BE STRUCK OUT.)
| 20 |
| 4. My agent shall have the right by written instrument to | 21 |
| delegate any
or all of the foregoing powers involving | 22 |
| discretionary decision-making to
any person or persons whom my | 23 |
| agent may select, but such delegation may be
amended or revoked | 24 |
| by any agent (including any successor) named by me who
is | 25 |
| acting under this power of attorney at the time of reference.
| 26 |
| (NOTE: Your agent will be entitled to reimbursement for all |
|
|
|
09600HB6477ham001 |
- 28 - |
LRB096 21113 AJO 39174 a |
|
| 1 |
| reasonable expenses incurred in acting under this power of | 2 |
| attorney. Strike out paragraph 5 if you do not want your agent | 3 |
| to also be entitled to reasonable compensation for services as | 4 |
| agent.) (YOUR AGENT WILL BE ENTITLED TO REIMBURSEMENT FOR ALL | 5 |
| REASONABLE EXPENSES
INCURRED IN ACTING UNDER THIS POWER OF | 6 |
| ATTORNEY. STRIKE OUT THE NEXT
SENTENCE IF YOU DO NOT WANT YOUR | 7 |
| AGENT TO ALSO BE ENTITLED TO REASONABLE
COMPENSATION FOR | 8 |
| SERVICES AS AGENT.)
| 9 |
| 5. My agent shall be entitled to reasonable compensation | 10 |
| for services
rendered as agent under this power of attorney.
| 11 |
| (NOTE: This power of attorney may be amended or revoked by you | 12 |
| at any time and in any manner. Absent amendment or revocation, | 13 |
| the authority granted in this power of attorney will become | 14 |
| effective at the time this power is signed and will continue | 15 |
| until your death, unless a limitation on the beginning date or | 16 |
| duration is made by initialing and completing one or both of | 17 |
| paragraphs 6 and 7:) (THIS POWER OF ATTORNEY MAY BE AMENDED OR | 18 |
| REVOKED BY YOU AT ANY TIME AND IN
ANY MANNER. ABSENT AMENDMENT | 19 |
| OR REVOCATION, THE AUTHORITY GRANTED IN THIS
POWER OF ATTORNEY | 20 |
| WILL BECOME EFFECTIVE AT THE TIME THIS POWER IS SIGNED
AND WILL | 21 |
| CONTINUE UNTIL YOUR DEATH UNLESS A LIMITATION ON THE BEGINNING
| 22 |
| DATE OR DURATION IS MADE BY INITIALING AND COMPLETING EITHER | 23 |
| (OR BOTH) OF
THE FOLLOWING:)
| 24 |
| 6. ( ) This power of attorney shall become effective on
| 25 |
| .............................................................
| 26 |
| ( NOTE: Insert insert a future date or event during your |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| lifetime, such as a court
determination of your disability or a | 2 |
| written determination by your physician that you are | 3 |
| incapacitated , when you want this power to first take effect . )
| 4 |
| 7. ( ) This power of attorney shall terminate on
| 5 |
| .............................................................
| 6 |
| ( NOTE: Insert insert a future date or event, such as a court | 7 |
| determination that you are not under a legal disability or a | 8 |
| written determination by your physician that you are not | 9 |
| incapacitated, if of your
disability, when you want this power | 10 |
| to terminate prior to your death . )
| 11 |
| (NOTE: If you wish to name one or more successor agents, insert | 12 |
| the name and address of each successor agent in paragraph 8.) | 13 |
| (IF YOU WISH TO NAME SUCCESSOR AGENTS, INSERT THE NAME(S) AND | 14 |
| ADDRESS(ES)
OF SUCH SUCCESSOR(S) IN THE FOLLOWING PARAGRAPH.)
| 15 |
| 8. If any agent named by me shall die, become incompetent, | 16 |
| resign
or refuse to accept the office of agent, I name the | 17 |
| following
(each to act alone and successively,
in the order | 18 |
| named) as successor(s) to such agent:
| 19 |
| .............................................................
| 20 |
| .............................................................
| 21 |
| For purposes of this paragraph 8, a person shall be considered | 22 |
| to be
incompetent if and while the person is a minor or an | 23 |
| adjudicated
incompetent or disabled person or the person is | 24 |
| unable to give prompt and
intelligent consideration to business | 25 |
| matters, as certified by a licensed physician.
| 26 |
| (NOTE: If you wish to, you may name your agent as guardian of |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| your estate if a court decides that one should be appointed. To | 2 |
| do this, retain paragraph 9, and the court will appoint your | 3 |
| agent if the court finds that this appointment will serve your | 4 |
| best interests and welfare. Strike out paragraph 9 if you do | 5 |
| not want your agent to act as guardian.) (IF YOU WISH TO NAME | 6 |
| YOUR AGENT AS
GUARDIAN OF YOUR ESTATE, IN THE EVENT A COURT | 7 |
| DECIDES THAT ONE
SHOULD BE APPOINTED, YOU
MAY, BUT ARE NOT | 8 |
| REQUIRED TO, DO SO BY RETAINING THE FOLLOWING PARAGRAPH.
THE | 9 |
| COURT
WILL APPOINT YOUR AGENT IF THE COURT FINDS THAT SUCH | 10 |
| APPOINTMENT WILL SERVE YOUR
BEST INTERESTS AND WELFARE. STRIKE | 11 |
| OUT PARAGRAPH 9 IF YOU DO NOT WANT
YOUR AGENT TO ACT AS | 12 |
| GUARDIAN.)
| 13 |
| 9. If a guardian of my estate (my property) is to be | 14 |
| appointed, I
nominate the agent acting under this power of | 15 |
| attorney as such guardian,
to serve without bond or security.
| 16 |
| 10. I am fully informed as to all the contents of this form | 17 |
| and
understand the full import of this grant of powers to my | 18 |
| agent.
| 19 |
| (NOTE: This form does not authorize your agent to appear in | 20 |
| court for you as an attorney-at-law or otherwise to engage in | 21 |
| the practice of law unless he or she is a licensed attorney who | 22 |
| is authorized to practice law in Illinois.) | 23 |
| 11. The Notice to Agent is incorporated by reference and | 24 |
| included as part of this form. | 25 |
| Dated: ................ | 26 |
| Signed ..........................................
|
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| (principal)
| 2 |
| (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 correct.
| 10 |
| .......................... .............................
| 11 |
| (agent) (principal)
| 12 |
| .......................... .............................
| 13 |
| (successor agent) (principal)
| 14 |
| .......................... .............................
| 15 |
| (successor agent) (principal)
| 16 |
| (NOTE: This power of attorney will not be effective unless it | 17 |
| is signed by at least one witness and your signature is | 18 |
| notarized, using the form below. The notary may not also sign | 19 |
| as a witness.) (THIS POWER OF ATTORNEY WILL NOT BE EFFECTIVE | 20 |
| UNLESS IT IS NOTARIZED AND
SIGNED BY AT LEAST ONE ADDITIONAL | 21 |
| WITNESS,
USING THE FORM BELOW.)
| 22 |
| The undersigned witness certifies that ..............., known | 23 |
| to me to be
the same person whose name is subscribed as | 24 |
| principal to the foregoing power of
attorney, appeared before |
|
|
|
09600HB6477ham001 |
- 32 - |
LRB096 21113 AJO 39174 a |
|
| 1 |
| me and the notary public and acknowledged signing and
| 2 |
| delivering the instrument as the free and voluntary act of the | 3 |
| principal, for
the
uses and purposes therein set forth. I | 4 |
| believe him or her to be of sound mind
and memory. The | 5 |
| undersigned witness also certifies that the witness is not: (a) | 6 |
| the attending physician or mental health service provider or a | 7 |
| relative of the physician or provider; (b) an owner, operator, | 8 |
| or relative of an owner or operator of a health care facility | 9 |
| in which the principal is a patient or resident; (c) a parent, | 10 |
| sibling, descendant, or any spouse of such parent, sibling, or | 11 |
| descendant of either the principal or any agent or successor | 12 |
| agent under the foregoing power of attorney, whether such | 13 |
| relationship is by blood, marriage, or adoption; or (d) an | 14 |
| agent or successor agent under the foregoing power of attorney.
| 15 |
| Dated: ................
| 16 |
| ..............................
| 17 |
| Witness
| 18 |
| (NOTE: Illinois requires only one witness, but other | 19 |
| jurisdictions may require more than one witness. If you wish to | 20 |
| have a second witness, have him or her certify and sign here:) | 21 |
| (Second witness) The undersigned witness certifies that | 22 |
| ................, known to me to be the same person whose name | 23 |
| is subscribed as principal to the foregoing power of attorney, | 24 |
| appeared before me and the notary public and acknowledged |
|
|
|
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LRB096 21113 AJO 39174 a |
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| 1 |
| signing and delivering the instrument as the free and voluntary | 2 |
| act of the principal, for the uses and purposes therein set | 3 |
| forth. I believe him or her to be of sound mind and memory. The | 4 |
| undersigned witness also certifies that the witness is not: (a) | 5 |
| the attending physician or mental health service provider or a | 6 |
| relative of the physician or provider; (b) an owner, operator, | 7 |
| or relative of an owner or operator of a health care facility | 8 |
| in which the principal is a patient or resident; (c) a parent, | 9 |
| sibling, descendant, or any spouse of such parent, sibling, or | 10 |
| descendant of either the principal or any agent or successor | 11 |
| agent under the foregoing power of attorney, whether such | 12 |
| relationship is by blood, marriage, or adoption; or (d) an | 13 |
| agent or successor agent under the foregoing power of attorney. | 14 |
| Dated: ....................... | 15 |
| ..............................
| 16 |
| Witness
| 17 |
| State of ............)
| 18 |
| ) SS.
| 19 |
| County of ...........)
| 20 |
| The undersigned, a notary public in and for the above | 21 |
| county and state,
certifies that ......................., | 22 |
| known to me to be the same person
whose name is subscribed as | 23 |
| principal to the foregoing power of attorney,
appeared before | 24 |
| me and the witness(es) ............. (and ..............) | 25 |
| additional witness in person and acknowledged
signing and |
|
|
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LRB096 21113 AJO 39174 a |
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| 1 |
| delivering the
instrument as the free and voluntary act of the | 2 |
| principal, for the uses and
purposes therein set forth (, and | 3 |
| certified to the correctness of the
signature(s) of the | 4 |
| agent(s)).
| 5 |
| Dated: ................ (SEAL)
| 6 |
| ..............................
| 7 |
| Notary Public
| 8 |
| My commission expires .................
| 9 |
| (NOTE: You may, but are not required to, request your agent and | 10 |
| successor agents to provide specimen signatures below. If you | 11 |
| include specimen signatures in this power of attorney, you must | 12 |
| complete the certification opposite the signatures of the | 13 |
| agents.)
| 14 |
| Specimen signatures of I certify that the signatures
| 15 |
| agent (and successors) of my agent (and successors)
| 16 |
| are genuine.
| 17 |
| .......................... .............................
| 18 |
| (agent) (principal)
| 19 |
| .......................... .............................
| 20 |
| (successor agent) (principal)
| 21 |
| .......................... .............................
| 22 |
| (successor agent) (principal) | 23 |
| The undersigned witness certifies that ................, known |
|
|
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09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
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| to me to be
the same person whose name is subscribed as | 2 |
| principal to the foregoing power of
attorney, appeared before | 3 |
| me and the notary public and acknowledged signing and
| 4 |
| delivering the instrument as the free and voluntary act of the | 5 |
| principal, for
the
uses and purposes therein set forth. I | 6 |
| believe him or her to be of sound mind
and memory.
| 7 |
| Dated: ................ (SEAL)
| 8 |
| ..............................
| 9 |
| Witness
| 10 |
| (NOTE: The name, address, and phone number of the person | 11 |
| preparing this form or who assisted the principal in completing | 12 |
| this form should be inserted below.) (THE NAME AND ADDRESS OF | 13 |
| THE PERSON PREPARING THIS FORM SHOULD BE
INSERTED
IF THE AGENT | 14 |
| WILL HAVE POWER TO CONVEY ANY INTEREST IN REAL ESTATE.)
| 15 |
| Name: ....................... | 16 |
| Address: .................... | 17 |
| .............................. | 18 |
| .............................. | 19 |
| Phone: .................... | 20 |
| This document was prepared by:
| 21 |
| .............................................................
| 22 |
| ............................................................."
| 23 |
| (e) Notice to Agent. The following form may be known as | 24 |
| "Notice to Agent" and shall be supplied to an agent appointed |
|
|
|
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LRB096 21113 AJO 39174 a |
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| 1 |
| under a power of attorney for property. | 2 |
| "NOTICE TO AGENT | 3 |
| When you accept the authority granted under this power of | 4 |
| attorney a special legal relationship, known as agency, is | 5 |
| created between you and the principal. Agency imposes upon you | 6 |
| duties that continue until you resign or the power of attorney | 7 |
| is terminated or revoked. | 8 |
| As agent you must: | 9 |
| (1) do what you know the principal reasonably expects | 10 |
| you to do with the principal's property; | 11 |
| (2) act in good faith for the best interest of the | 12 |
| principal, using due care, competence, and diligence; | 13 |
| (3) keep a complete and detailed record of all | 14 |
| receipts, disbursements, and significant actions conducted | 15 |
| for the principal; | 16 |
| (4) attempt to preserve the principal's estate plan, to | 17 |
| the extent actually known by the agent, if preserving the | 18 |
| plan is consistent with the principal's best interest; and | 19 |
| (5) cooperate with a person who has authority to make | 20 |
| health care decisions for the principal to carry out the | 21 |
| principal's reasonable expectations to the extent actually | 22 |
| in the principal's best interest. | 23 |
| As agent you must not do any of the following: | 24 |
| (1) act so as to create a conflict of interest that is | 25 |
| inconsistent with the other principles in this Notice to |
|
|
|
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LRB096 21113 AJO 39174 a |
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| Agent; | 2 |
| (2) do any act beyond the authority granted in this | 3 |
| power of attorney; | 4 |
| (3) commingle the principal's funds with your funds; | 5 |
| (4) borrow funds or other property from the principal, | 6 |
| unless otherwise authorized; | 7 |
| (5) continue acting on behalf of the principal if you | 8 |
| learn of any event that terminates this power of attorney | 9 |
| or your authority under this power of attorney, such as the | 10 |
| death of the principal, your legal separation from the | 11 |
| principal, or the dissolution of your marriage to the | 12 |
| principal. | 13 |
| If you have special skills or expertise, you must use those | 14 |
| special skills and expertise when acting for the principal. You | 15 |
| must disclose your identity as an agent whenever you act for | 16 |
| the principal by writing or printing the name of the principal | 17 |
| and signing your own name "as Agent" in the following manner: | 18 |
| "(Principal's Name) by (Your Name) as Agent" | 19 |
| The meaning of the powers granted to you is contained in | 20 |
| Section 3-4 of the Illinois Power of Attorney Act, which is | 21 |
| incorporated by reference into the body of the power of | 22 |
| attorney for property document. | 23 |
| If you violate your duties as agent or act outside the | 24 |
| authority granted to you, you may be liable for any damages, | 25 |
| including attorney's fees and costs, caused by your violation. | 26 |
| If there is anything about this document or your duties |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
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| 1 |
| that you do not understand, you should seek legal advice from | 2 |
| an attorney." | 3 |
| (f) The requirement of the signature of a witness in | 4 |
| addition to the principal and the notary, an additional
witness | 5 |
| imposed by Public Act 91-790, this amendatory Act of the 91st | 6 |
| General
Assembly applies only to instruments executed on or | 7 |
| after June 9, 2000 ( the effective date of that Public Act). | 8 |
| this amendatory Act of the 91st
General Assembly. | 9 |
| (NOTE: This amendatory Act of the 96th General Assembly deletes | 10 |
| provisions that referred to the one required witness as an | 11 |
| "additional witness", and it also provides for the signature of | 12 |
| an optional "second witness".)
| 13 |
| (Source: P.A. 91-790, eff. 6-9-00 .)
| 14 |
| (755 ILCS 45/3-3.6 new) | 15 |
| Sec. 3-3.6. Limitations on who may witness property powers. | 16 |
| (a) Every property power shall bear the signature of a | 17 |
| witness to the signing of the agency and shall be notarized. | 18 |
| None of the following may serve as a witness to the signing of | 19 |
| a property power or as a notary public notarizing the property | 20 |
| power: | 21 |
| (1) the attending physician or mental health service | 22 |
| provider of the principal, or a relative of the physician | 23 |
| or provider; | 24 |
| (2) an owner, operator, or relative of an owner or |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
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| 1 |
| operator of a health care facility in which the principal | 2 |
| is a patient or resident; | 3 |
| (3) a parent, sibling, or descendant, or the spouse of | 4 |
| a parent, sibling, or descendant, of either the principal | 5 |
| or any agent or successor agent, regardless of whether the | 6 |
| relationship is by blood, marriage, or adoption; | 7 |
| (4) an agent or successor agent for property. | 8 |
| (b) The prohibition on the operator of a health care | 9 |
| facility from serving as a witness shall extend to directors | 10 |
| and executive officers of an operator that is a corporate | 11 |
| entity but not other employees of the operator.
| 12 |
| (755 ILCS 45/3-4) (from Ch. 110 1/2, par. 803-4)
| 13 |
| Sec. 3-4. Explanation of powers granted in the statutory | 14 |
| short form power
of attorney for property. This Section defines | 15 |
| each category of powers
listed in the statutory short form | 16 |
| power of attorney for property and the
effect of granting | 17 |
| powers to an agent , and is incorporated by reference into the | 18 |
| statutory short form. Incorporation by reference does not | 19 |
| require physical attachment of a copy of this Section 3-4 to | 20 |
| the statutory short form power of attorney for property . When | 21 |
| the title of any of the
following categories is retained (not | 22 |
| struck out) in a statutory property
power form, the effect will | 23 |
| be to grant the agent all of the principal's
rights, powers and | 24 |
| discretions with respect to the types of property and
| 25 |
| transactions covered by the retained category, subject to any |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| limitations
on the granted powers that appear on the face of | 2 |
| the form. The agent will
have authority to exercise each | 3 |
| granted power for and in the name of the
principal with respect | 4 |
| to all of the principal's interests in every type of
property | 5 |
| or transaction covered by the granted power at the time of
| 6 |
| exercise, whether the principal's interests are direct or | 7 |
| indirect, whole
or fractional, legal, equitable or | 8 |
| contractual, as a joint tenant or tenant
in common or held in | 9 |
| any other form; but the agent will not have power under
any of | 10 |
| the statutory categories (a) through (o) to make gifts of the
| 11 |
| principal's property, to exercise powers to appoint to others | 12 |
| or to change
any beneficiary whom the principal has designated | 13 |
| to take the principal's
interests at death under any will, | 14 |
| trust, joint tenancy, beneficiary form
or contractual | 15 |
| arrangement. The agent will be under no duty to exercise
| 16 |
| granted powers or to assume control of or responsibility for | 17 |
| the
principal's property or affairs; but when granted powers | 18 |
| are exercised, the
agent will be required to use due care to | 19 |
| act in good faith for the benefit of
the principal using due | 20 |
| care, competence, and diligence in accordance with the terms of | 21 |
| the statutory property power
and will be liable for negligent | 22 |
| exercise. The agent may act in person or
through others | 23 |
| reasonably employed by the agent for that purpose and will
have | 24 |
| authority to sign and deliver all instruments, negotiate and | 25 |
| enter
into all agreements and do all other acts reasonably | 26 |
| necessary to implement
the exercise of the powers granted to |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| the agent.
| 2 |
| (a) Real estate transactions. The agent is authorized to: | 3 |
| buy,
sell, exchange, rent and lease real estate (which term | 4 |
| includes, without
limitation, real estate subject to a land | 5 |
| trust and all beneficial
interests in and powers of direction | 6 |
| under any land trust); collect all
rent, sale proceeds and | 7 |
| earnings from real estate; convey, assign and
accept title to | 8 |
| real estate; grant easements, create conditions and release
| 9 |
| rights of homestead with respect to real estate; create land | 10 |
| trusts and
exercise all powers under land trusts; hold, | 11 |
| possess, maintain, repair,
improve, subdivide, manage, operate | 12 |
| and insure real estate; pay, contest,
protest and compromise | 13 |
| real estate taxes and assessments; and, in general,
exercise | 14 |
| all powers with respect to real estate which the principal | 15 |
| could
if present and under no disability.
| 16 |
| (b) Financial institution transactions. The agent is | 17 |
| authorized to:
open, close, continue and control all accounts | 18 |
| and deposits in any type of
financial institution (which term | 19 |
| includes, without limitation, banks,
trust companies, savings | 20 |
| and building and loan associations, credit unions
and brokerage | 21 |
| firms); deposit in and withdraw from and write checks on any
| 22 |
| financial institution account or deposit; and, in general, | 23 |
| exercise all
powers with respect to financial institution | 24 |
| transactions which the
principal could if present and under no | 25 |
| disability. This authorization shall also apply to any Totten | 26 |
| Trust, Payable on Death Account, or comparable trust account |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| arrangement where the terms of such trust are contained | 2 |
| entirely on the financial institution's signature card, | 3 |
| insofar as an agent shall be permitted to withdraw income or | 4 |
| principal from such account, unless this authorization is | 5 |
| expressly limited or withheld under paragraph 2 of the form | 6 |
| prescribed under Section 3-3. This authorization shall not | 7 |
| apply to accounts titled in the name of any trust subject to | 8 |
| the provisions of the Trusts and Trustees Act, for which | 9 |
| specific reference to the trust and a specific grant of | 10 |
| authority to the agent to withdraw income or principal from | 11 |
| such trust is required pursuant to Section 2-9 of the Illinois | 12 |
| Power of Attorney Act and subsection (n) of this Section.
| 13 |
| (c) Stock and bond transactions. The agent is authorized | 14 |
| to: buy
and sell all types of securities (which term includes, | 15 |
| without limitation,
stocks, bonds, mutual funds and all other | 16 |
| types of investment securities
and financial instruments); | 17 |
| collect, hold and safekeep all dividends,
interest, earnings, | 18 |
| proceeds of sale, distributions, shares, certificates
and | 19 |
| other evidences of ownership paid or distributed with respect | 20 |
| to
securities; exercise all voting rights with respect to | 21 |
| securities in person
or by proxy, enter into voting trusts and | 22 |
| consent to limitations on the
right to vote; and, in general, | 23 |
| exercise all powers with respect to
securities which the | 24 |
| principal could if present and under no disability.
| 25 |
| (d) Tangible personal property transactions. The agent is
| 26 |
| authorized to: buy and sell, lease, exchange, collect, possess |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| and take
title to all tangible personal property; move, store, | 2 |
| ship, restore,
maintain, repair, improve, manage, preserve, | 3 |
| insure and safekeep tangible
personal property; and, in | 4 |
| general, exercise all powers with respect to
tangible personal | 5 |
| property which the principal could if present and under no | 6 |
| disability.
| 7 |
| (e) Safe deposit box transactions. The agent is authorized | 8 |
| to:
open, continue and have access to all safe deposit boxes; | 9 |
| sign, renew,
release or terminate any safe deposit contract; | 10 |
| drill or surrender any safe
deposit box; and, in general, | 11 |
| exercise all powers with respect to safe
deposit matters which | 12 |
| the principal could if present and under no disability.
| 13 |
| (f) Insurance and annuity transactions. The agent is | 14 |
| authorized to:
procure, acquire, continue, renew, terminate or | 15 |
| otherwise deal with any
type of insurance or annuity contract | 16 |
| (which terms include, without
limitation, life, accident, | 17 |
| health, disability, automobile casualty,
property or liability | 18 |
| insurance); pay premiums or assessments on or
surrender and | 19 |
| collect all distributions, proceeds or benefits payable under
| 20 |
| any insurance or annuity contract; and, in general, exercise | 21 |
| all powers
with respect to insurance and annuity contracts | 22 |
| which the principal could
if present and under no disability.
| 23 |
| (g) Retirement plan transactions. The agent is authorized | 24 |
| to:
contribute to, withdraw from and deposit funds in any type | 25 |
| of retirement
plan (which term includes, without limitation, | 26 |
| any tax qualified or
nonqualified pension, profit sharing, |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| stock bonus, employee savings and
other retirement plan, | 2 |
| individual retirement account, deferred compensation
plan and | 3 |
| any other type of employee benefit plan); select and change
| 4 |
| payment options for the principal under any retirement plan; | 5 |
| make rollover
contributions from any retirement plan to other | 6 |
| retirement plans or
individual retirement accounts; exercise | 7 |
| all investment powers available
under any type of self-directed | 8 |
| retirement plan; and, in general, exercise
all powers with | 9 |
| respect to retirement plans and retirement plan account
| 10 |
| balances which the principal could if present and under no | 11 |
| disability.
| 12 |
| (h) Social Security, unemployment and military service | 13 |
| benefits.
The agent is authorized to: prepare, sign and file | 14 |
| any claim or application
for Social Security, unemployment or | 15 |
| military service benefits; sue for,
settle or abandon any | 16 |
| claims to any benefit or assistance under any
federal, state, | 17 |
| local or foreign statute or regulation; control, deposit to
any | 18 |
| account, collect, receipt for, and take title to and hold all | 19 |
| benefits
under any Social Security, unemployment, military | 20 |
| service or other state,
federal, local or foreign statute or | 21 |
| regulation; and, in general, exercise
all powers with respect | 22 |
| to Social Security, unemployment, military service
and | 23 |
| governmental benefits which the principal could if present and | 24 |
| under no disability.
| 25 |
| (i) Tax matters. The agent is authorized to: sign, verify | 26 |
| and file
all the principal's federal, state and local income, |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| gift, estate, property
and other tax returns, including joint | 2 |
| returns and declarations of
estimated tax; pay all taxes; | 3 |
| claim, sue for and receive all tax refunds;
examine and copy | 4 |
| all the principal's tax returns and records; represent the
| 5 |
| principal before any federal, state or local revenue agency or | 6 |
| taxing body
and sign and deliver all tax powers of attorney on | 7 |
| behalf of the principal
that may be necessary for such | 8 |
| purposes; waive rights and sign all
documents on behalf of the | 9 |
| principal as required to settle, pay and
determine all tax | 10 |
| liabilities; and, in general, exercise all powers with
respect | 11 |
| to tax matters which the principal could if present and under | 12 |
| no disability.
| 13 |
| (j) Claims and litigation. The agent is authorized to: | 14 |
| institute,
prosecute, defend, abandon, compromise, arbitrate, | 15 |
| settle and dispose of
any claim in favor of or against the | 16 |
| principal or any property interests of
the principal; collect | 17 |
| and receipt for any claim or settlement proceeds and
waive or | 18 |
| release all rights of the principal; employ attorneys and | 19 |
| others
and enter into contingency agreements and other | 20 |
| contracts as necessary in
connection with litigation; and, in | 21 |
| general, exercise all powers with
respect to claims and | 22 |
| litigation which the principal could if present and
under no | 23 |
| disability. The statutory short form power
of attorney for | 24 |
| property does not authorize the agent to appear in court or any | 25 |
| tribunal as an attorney-at-law for the principal or otherwise | 26 |
| to engage in the practice of law without being a licensed |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| attorney who is authorized to practice law in Illinois under | 2 |
| applicable Illinois Supreme Court Rules.
| 3 |
| (k) Commodity and option transactions. The agent is | 4 |
| authorized to:
buy, sell, exchange, assign, convey, settle and | 5 |
| exercise commodities
futures contracts and call and put options | 6 |
| on stocks and stock indices
traded on a regulated options | 7 |
| exchange and collect and receipt for all
proceeds of any such | 8 |
| transactions; establish or continue option accounts
for the | 9 |
| principal with any securities or futures broker; and, in | 10 |
| general,
exercise all powers with respect to commodities and | 11 |
| options which the
principal could if present and under no | 12 |
| disability.
| 13 |
| (l) Business operations. The agent is authorized to: | 14 |
| organize or
continue and conduct any business (which term | 15 |
| includes, without limitation,
any farming, manufacturing, | 16 |
| service, mining, retailing or other type of
business operation) | 17 |
| in any form, whether as a proprietorship, joint
venture, | 18 |
| partnership, corporation, trust or other legal entity; | 19 |
| operate,
buy, sell, expand, contract, terminate or liquidate | 20 |
| any business; direct,
control, supervise, manage or | 21 |
| participate in the operation of any business
and engage, | 22 |
| compensate and discharge business managers, employees, agents,
| 23 |
| attorneys, accountants and consultants; and, in general, | 24 |
| exercise all
powers with respect to business interests and | 25 |
| operations which the principal
could if present and under no | 26 |
| disability.
|
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| (m) Borrowing transactions. The agent is authorized to: | 2 |
| borrow
money; mortgage or pledge any real estate or tangible or | 3 |
| intangible
personal property as security for such purposes; | 4 |
| sign, renew, extend, pay
and satisfy any notes or other forms | 5 |
| of obligation; and, in general,
exercise all powers with | 6 |
| respect to secured and unsecured borrowing which
the principal | 7 |
| could if present and under no disability.
| 8 |
| (n) Estate transactions. The agent is authorized to: | 9 |
| accept,
receipt for, exercise, release, reject, renounce, | 10 |
| assign, disclaim, demand,
sue for, claim and recover any | 11 |
| legacy, bequest, devise, gift or other
property interest or | 12 |
| payment due or payable to or for the principal; assert
any | 13 |
| interest in and exercise any power over any trust, estate or | 14 |
| property
subject to fiduciary control; establish a revocable | 15 |
| trust solely for the
benefit of the principal that terminates | 16 |
| at the death of the principal and
is then distributable to the | 17 |
| legal representative of the estate of the
principal; and, in | 18 |
| general, exercise all powers with respect to estates and
trusts | 19 |
| which the principal could if present and under no disability;
| 20 |
| provided, however, that the agent may not make or change a will | 21 |
| and may not
revoke or amend a trust revocable or amendable by | 22 |
| the principal or require
the trustee of any trust for the | 23 |
| benefit of the principal to pay income or
principal to the | 24 |
| agent unless specific authority to that end is given, and
| 25 |
| specific reference to the trust is made, in the statutory | 26 |
| property power form.
|
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| (o) All other property powers and transactions. The agent | 2 |
| is
authorized to: exercise all possible authority powers of the | 3 |
| principal with respect
to all possible types of property and | 4 |
| interests in property, except to the
extent limited in | 5 |
| subsections (a) through (n) of this Section 3-4 and to the | 6 |
| extent that the principal otherwise limits the generality of | 7 |
| this category (o) by striking
out one or more of categories (a) | 8 |
| through (n) or by specifying other
limitations in the statutory | 9 |
| property power form.
| 10 |
| (Source: P.A. 94-938, eff. 1-1-07.)
| 11 |
| (755 ILCS 45/3-5 new) | 12 |
| Sec. 3-5. Savings clause. This amendatory Act of the 96th | 13 |
| General Assembly does not in any way invalidate any property | 14 |
| power executed or any act of any agent done, or affect any | 15 |
| claim, right, or remedy that accrued, prior to the effective | 16 |
| date of this amendatory Act of the 96th General Assembly.
| 17 |
| (755 ILCS 45/4-4) (from Ch. 110 1/2, par. 804-4)
| 18 |
| Sec. 4-4. Definitions. As used in this Article:
| 19 |
| (a) "Attending physician" means the physician who has | 20 |
| primary
responsibility at the time of reference for the | 21 |
| treatment and care of the patient.
| 22 |
| (b) "Health care" means any care, treatment, service or | 23 |
| procedure to
maintain, diagnose, treat or provide for the | 24 |
| patient's physical or mental
health or personal care.
|
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| (c) "Health care agency" means an agency governing any type | 2 |
| of health
care, anatomical gift, autopsy or disposition of | 3 |
| remains for and on behalf
of a patient and refers to the power | 4 |
| of attorney or other written
instrument defining the agency or | 5 |
| the agency, itself, as appropriate to the context.
| 6 |
| (d) "Health care provider" or "provider" means the | 7 |
| attending physician
and any other person administering health | 8 |
| care to the patient at the time
of reference who is licensed, | 9 |
| certified, or otherwise authorized or
permitted by law to | 10 |
| administer health care in the ordinary course of
business or | 11 |
| the practice of a profession, including any person employed by
| 12 |
| or acting for any such authorized person.
| 13 |
| (e) "Patient" means the principal or, if the agency governs | 14 |
| health care
for a minor child of the principal, then the child.
| 15 |
| (f) "Incurable or irreversible condition" means an illness | 16 |
| or injury (i) for which there is no reasonable prospect of cure | 17 |
| or recovery, (ii) that ultimately will cause the patient's | 18 |
| death even if life-sustaining treatment is initiated or | 19 |
| continued, (iii) that imposes severe pain or otherwise imposes | 20 |
| an inhumane burden on the patient, or (iv) for which initiating | 21 |
| or continuing life-sustaining treatment, in light of the | 22 |
| patient's medical condition, provides only minimal medical | 23 |
| benefit. | 24 |
| (g) "Permanent unconsciousness" means a condition that, to | 25 |
| a high degree of medical certainty, (i) will last permanently, | 26 |
| without improvement, (ii) in which thought, sensation, |
|
|
|
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LRB096 21113 AJO 39174 a |
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| 1 |
| purposeful action, social interaction, and awareness of self | 2 |
| and environment are absent, and (iii) for which initiating or | 3 |
| continuing life-sustaining treatment, in light of the | 4 |
| patient's medical condition, provides only minimal medical | 5 |
| benefit. For the purposes of this definition, "medical benefit" | 6 |
| means a chance to cure or reverse a condition. | 7 |
| (h) "Terminal condition" means an illness or injury for | 8 |
| which there is no reasonable prospect of cure or recovery, | 9 |
| death is imminent, and the application of life-sustaining | 10 |
| treatment would only prolong the dying process. | 11 |
| (Source: P.A. 85-701.)
| 12 |
| (755 ILCS 45/4-5.1 new) | 13 |
| Sec. 4-5.1. Limitations on who may witness health care | 14 |
| agencies. | 15 |
| (a) Every health care agency shall bear the signature of a | 16 |
| witness to the signing of the agency. None of the following may | 17 |
| serve as a witness to the signing of a health care agency: | 18 |
| (1) the attending physician or mental health service | 19 |
| provider of the principal, or a relative of the physician | 20 |
| or provider; | 21 |
| (2) an owner, operator, or relative of an owner or | 22 |
| operator of a health care facility in which the principal | 23 |
| is a patient or resident; | 24 |
| (3) a parent, sibling, or descendant, or the spouse of | 25 |
| a parent, sibling, or descendant, of either the principal |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
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| or any agent or successor agent, regardless of whether the | 2 |
| relationship is by blood, marriage, or adoption; | 3 |
| (4) an agent or successor agent for health care. | 4 |
| (b) The prohibition on the operator of a health care | 5 |
| facility from serving as a witness shall extend to directors | 6 |
| and executive officers of an operator that is a corporate | 7 |
| entity but not other employees of the operator.
| 8 |
| (755 ILCS 45/4-10) (from Ch. 110 1/2, par. 804-10)
| 9 |
| Sec. 4-10. Statutory short form power of attorney for | 10 |
| health care.
| 11 |
| (a) The following form prescribed in this Section | 12 |
| (sometimes also referred to in this Act as the
"statutory | 13 |
| health care power") may be used to grant an agent powers with
| 14 |
| respect to the principal's own health care; but the statutory | 15 |
| health care
power is not intended to be exclusive nor to cover | 16 |
| delegation of a parent's
power to control the health care of a | 17 |
| minor child, and no provision of this
Article shall be | 18 |
| construed to invalidate or bar use by the principal of any
| 19 |
| other or
different form of power of attorney for health care. | 20 |
| Nonstatutory health
care powers must be
executed by the | 21 |
| principal, designate the agent and the agent's powers, and
| 22 |
| comply with Section 4-5 of this Article, but they need not be | 23 |
| witnessed or
conform in any other respect to the statutory | 24 |
| health care power. When a
power of attorney in substantially | 25 |
| the
following form prescribed in this Section is used, |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| including the "Notice to the Individual Signing the Illinois | 2 |
| Statutory Short Form Power of Attorney for Health Care" (or | 3 |
| "Notice" paragraphs) "notice" paragraph at the beginning of the | 4 |
| form on a separate sheet in 14-point type
in capital letters , | 5 |
| it shall have the meaning and effect prescribed in this
Act. A | 6 |
| power of attorney for health care shall be deemed to be in | 7 |
| substantially the same format as the statutory form if the | 8 |
| explanatory language throughout the form (the language | 9 |
| following the designation "NOTE:") is distinguished in some way | 10 |
| from the legal paragraphs in the form, such as the use of | 11 |
| boldface or other difference in typeface and font or point | 12 |
| size, even if the "Notice" paragraphs at the beginning are not | 13 |
| on a separate sheet of paper or are not in 14-point type, or if | 14 |
| the principal's initials do not appear in the acknowledgement | 15 |
| at the end of the "Notice" paragraphs. The statutory health | 16 |
| care power may be included in or
combined with any
other form | 17 |
| of power of attorney governing property or other matters.
| 18 |
| (b) The Illinois Statutory Short Form Power of Attorney for | 19 |
| Health Care shall be substantially as follows: | 20 |
| "NOTICE TO THE INDIVIDUAL SIGNING THE ILLINOIS | 21 |
| STATUTORY SHORT FORM POWER OF ATTORNEY FOR HEALTH CARE | 22 |
| PLEASE READ THIS NOTICE CAREFULLY. The form that you will | 23 |
| be signing is a legal document. It is governed by the Illinois | 24 |
| Power of Attorney Act. If there is anything about this form |
|
|
|
09600HB6477ham001 |
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| 1 |
| that you do not understand, you should ask a lawyer to explain | 2 |
| it to you. | 3 |
| The purpose of this Power of Attorney is to give your | 4 |
| designated "agent" broad powers to make health care decisions | 5 |
| for you, including the power to require, consent to, or | 6 |
| withdraw treatment for any physical or mental condition, and to | 7 |
| admit you or discharge you from any hospital, home, or other | 8 |
| institution. You may name successor agents under this form, but | 9 |
| you may not name co-agents. | 10 |
| This form does not impose a duty upon your agent to make | 11 |
| such health care decisions, so it is important that you select | 12 |
| an agent who will agree to do this for you and who will make | 13 |
| those decisions as you would wish. It is also important to | 14 |
| select an agent whom you trust, since you are giving that agent | 15 |
| control over your medical decision-making, including | 16 |
| end-of-life decisions. Any agent who does act for you has a | 17 |
| duty to act in good faith for your benefit and to use due care, | 18 |
| competence, and diligence. He or she must also act in | 19 |
| accordance with the law and with the statements in this form. | 20 |
| Your agent must keep a record of all significant actions taken | 21 |
| as your agent. | 22 |
| Unless you specifically limit the period of time that this | 23 |
| Power of Attorney will be in effect, your agent may exercise | 24 |
| the powers given to him or her throughout your lifetime, even | 25 |
| after you become disabled. A court, however, can take away the | 26 |
| powers of your agent if it finds that the agent is not acting |
|
|
|
09600HB6477ham001 |
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| 1 |
| properly. You may also revoke this Power of Attorney if you | 2 |
| wish. | 3 |
| The Powers you give your agent, your right to revoke those | 4 |
| powers, and the penalties for violating the law are explained | 5 |
| more fully in Sections 4-5, 4-6, and 4-10(b) of the Illinois | 6 |
| Power of Attorney Act. This form is a part of that law. The | 7 |
| "NOTE" paragraphs throughout this form are instructions. | 8 |
| You are not required to sign this Power of Attorney, but it | 9 |
| will not take effect without your signature. You should not | 10 |
| sign it if you do not understand everything in it, and what | 11 |
| your agent will be able to do if you do sign it. | 12 |
| Please put your initials on the following line indicating | 13 |
| that you have read this Notice: | 14 |
| ......................
| 15 |
| (Principal's initials)"
| 16 |
| "ILLINOIS STATUTORY SHORT FORM | 17 |
| POWER OF ATTORNEY FOR HEALTH CARE
| 18 |
| (NOTICE: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE | 19 |
| THE PERSON YOU
DESIGNATE (YOUR "AGENT") BROAD POWERS TO MAKE | 20 |
| HEALTH CARE DECISIONS FOR YOU,
INCLUDING POWER TO REQUIRE, | 21 |
| CONSENT TO OR WITHDRAW ANY TYPE OF PERSONAL
CARE OR MEDICAL | 22 |
| TREATMENT FOR ANY PHYSICAL OR MENTAL CONDITION AND TO ADMIT
YOU | 23 |
| TO OR DISCHARGE YOU FROM ANY HOSPITAL, HOME OR OTHER |
|
|
|
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| 1 |
| INSTITUTION. THIS
FORM DOES NOT IMPOSE A DUTY ON YOUR AGENT TO | 2 |
| EXERCISE GRANTED POWERS; BUT
WHEN POWERS ARE EXERCISED, YOUR | 3 |
| AGENT WILL HAVE TO USE
DUE CARE TO ACT FOR
YOUR BENEFIT AND IN | 4 |
| ACCORDANCE WITH THIS FORM AND KEEP A RECORD OF
RECEIPTS, | 5 |
| DISBURSEMENTS AND SIGNIFICANT ACTIONS TAKEN AS AGENT. A COURT
| 6 |
| CAN TAKE AWAY THE
POWERS OF YOUR AGENT IF IT FINDS THE AGENT IS | 7 |
| NOT ACTING PROPERLY. YOU MAY
NAME SUCCESSOR AGENTS UNDER THIS | 8 |
| FORM
BUT NOT CO-AGENTS, AND NO HEALTH CARE PROVIDER MAY BE | 9 |
| NAMED. UNLESS
YOU EXPRESSLY LIMIT THE DURATION OF THIS POWER
IN | 10 |
| THE MANNER PROVIDED BELOW, UNTIL YOU REVOKE THIS POWER OR A | 11 |
| COURT ACTING
ON YOUR BEHALF TERMINATES IT, YOUR AGENT MAY | 12 |
| EXERCISE THE POWERS GIVEN HERE
THROUGHOUT YOUR LIFETIME, EVEN | 13 |
| AFTER YOU BECOME DISABLED. THE POWERS YOU
GIVE YOUR AGENT, YOUR | 14 |
| RIGHT TO REVOKE THOSE POWERS AND THE PENALTIES FOR
VIOLATING | 15 |
| THE LAW ARE EXPLAINED MORE FULLY IN SECTIONS 4-5, 4-6, 4-9 AND
| 16 |
| 4-10(b) OF THE ILLINOIS
"POWERS OF ATTORNEY FOR HEALTH CARE | 17 |
| LAW"
OF WHICH THIS FORM IS A PART (SEE THE BACK OF THIS FORM). | 18 |
| THAT LAW
EXPRESSLY PERMITS THE USE OF ANY DIFFERENT FORM OF | 19 |
| POWER OF ATTORNEY YOU
MAY DESIRE. IF THERE IS ANYTHING ABOUT | 20 |
| THIS FORM THAT YOU DO NOT
UNDERSTAND, YOU SHOULD ASK A LAWYER | 21 |
| TO EXPLAIN IT TO YOU.)
| 22 |
| POWER OF ATTORNEY made this .......................day of
| 23 |
| ................................
| 24 |
| (month) (year)
| 25 |
| 1. I, ..................................................,
| 26 |
| (insert name and address of principal)
hereby revoke all prior |
|
|
|
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LRB096 21113 AJO 39174 a |
|
| 1 |
| powers of attorney for health care executed by me and appoint:
| 2 |
| ............................................................
| 3 |
| (insert name and address of agent)
| 4 |
| (NOTE: You may not name co-agents using this form.) | 5 |
| as my attorney-in-fact (my "agent") to act for me and in my | 6 |
| name (in any
way I could act in person) to make any and all | 7 |
| decisions for me concerning
my personal care, medical | 8 |
| treatment, hospitalization and health care and to
require, | 9 |
| withhold or withdraw any type of medical treatment or | 10 |
| procedure,
even though my death may ensue. | 11 |
| A. My agent shall have the same access to my
medical | 12 |
| records that I have, including the right to disclose the | 13 |
| contents
to others. My agent shall also have full power to
| 14 |
| authorize an autopsy and direct the disposition of my remains. | 15 |
| B.
Effective upon my death, my agent has the full power to | 16 |
| make an anatomical
gift of the following (initial one) : | 17 |
| (NOTE: Initial one. In the event none of the options are | 18 |
| initialed, then it shall be concluded that you do not wish to | 19 |
| grant your agent any such authority.)
| 20 |
| .... Any organs, tissues, or eyes suitable for | 21 |
| transplantation or used for
research or education.
| 22 |
| .... Specific organs: ................................
| 23 |
| .... I do not grant my agent authority to make any | 24 |
| anatomical gifts. | 25 |
| C. My agent shall also have full power to authorize an | 26 |
| autopsy and direct the disposition of my remains. I intend for |
|
|
|
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|
| 1 |
| this power of attorney to be in substantial compliance with | 2 |
| Section 10 of the Disposition of Remains Act. All decisions | 3 |
| made by my agent with respect to the disposition of my remains, | 4 |
| including cremation, shall be binding. I hereby direct any | 5 |
| cemetery organization, business operating a crematory or | 6 |
| columbarium or both, funeral director or embalmer, or funeral | 7 |
| establishment who receives a copy of this document to act under | 8 |
| it. | 9 |
| D. I intend for the person named as my agent to be treated | 10 |
| as I would be with respect to my rights regarding the use and | 11 |
| disclosure of my individually identifiable health information | 12 |
| or other medical records, including records or communications | 13 |
| governed by the Mental Health and Developmental Disabilities | 14 |
| Confidentiality Act. This release authority applies to any | 15 |
| information governed by the Health Insurance Portability and | 16 |
| Accountability Act of 1996 ("HIPAA") and regulations | 17 |
| thereunder. I intend for the person named as my agent to serve | 18 |
| as my "personal representative" as that term is defined under | 19 |
| HIPAA and regulations thereunder. | 20 |
| (i) The person named as my agent shall have the power to | 21 |
| authorize the release of information governed by HIPAA to third | 22 |
| parties. | 23 |
| (ii) I authorize any physician, health care professional, | 24 |
| dentist, health plan, hospital, clinic, laboratory, pharmacy | 25 |
| or other covered health care provider, any insurance company | 26 |
| and the Medical Informational Bureau, Inc., or any other health |
|
|
|
09600HB6477ham001 |
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|
| 1 |
| care clearinghouse that has provided treatment or services to | 2 |
| me, or that has paid for or is seeking payment for me for such | 3 |
| services to give, disclose, and release to the person named as | 4 |
| my agent, without restriction, all of my individually | 5 |
| identifiable health information and medical records, regarding | 6 |
| any past, present, or future medical or mental health | 7 |
| condition, including all information relating to the diagnosis | 8 |
| and treatment of HIV/AIDS, sexually transmitted diseases, drug | 9 |
| or alcohol abuse, and mental illness (including records or | 10 |
| communications governed by the Mental Health and Developmental | 11 |
| Disabilities Confidentiality Act). | 12 |
| (iii) The authority given to the person named as my agent | 13 |
| shall supersede any prior agreement that I may have with my | 14 |
| health care providers to restrict access to, or disclosure of, | 15 |
| my individually identifiable health information. The authority | 16 |
| given to the person named as my agent has no expiration date | 17 |
| and shall expire only in the event that I revoke the authority | 18 |
| in writing and deliver it to my health care provider. The | 19 |
| authority given to the person named as my agent to serve as my | 20 |
| "personal representative" as defined under HIPAA and | 21 |
| regulations thereunder and to access my individually | 22 |
| identifiable health information or authorize the release of the | 23 |
| same to third parties shall take effect immediately, even if I | 24 |
| designate in Paragraph 3 of this document that this agency | 25 |
| shall otherwise take effect at some future date. | 26 |
| (NOTE: The above grant of power is intended to be as broad as |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| possible so that your agent will have the authority to make any | 2 |
| decision you could make to obtain or terminate any type of | 3 |
| health care, including withdrawal of food and water and other | 4 |
| life-sustaining measures, if your agent believes such action | 5 |
| would be consistent with your intent and desires. If you wish | 6 |
| to limit the scope of your agent's powers or prescribe special | 7 |
| rules or limit the power to make an anatomical gift, authorize | 8 |
| autopsy or dispose of remains, you may do so in the following | 9 |
| paragraphs.) (THE ABOVE GRANT OF POWER IS INTENDED TO BE AS | 10 |
| BROAD AS POSSIBLE SO THAT
YOUR AGENT WILL HAVE AUTHORITY TO | 11 |
| MAKE ANY DECISION YOU COULD MAKE TO
OBTAIN OR TERMINATE ANY | 12 |
| TYPE OF HEALTH CARE, INCLUDING WITHDRAWAL OF FOOD
AND WATER AND | 13 |
| OTHER LIFE-SUSTAINING MEASURES, IF YOUR AGENT BELIEVES SUCH
| 14 |
| ACTION WOULD BE CONSISTENT WITH YOUR INTENT AND DESIRES. IF YOU | 15 |
| WISH TO
LIMIT THE SCOPE OF YOUR AGENT'S POWERS OR PRESCRIBE | 16 |
| SPECIAL RULES OR LIMIT
THE POWER TO MAKE AN ANATOMICAL GIFT, | 17 |
| AUTHORIZE AUTOPSY OR DISPOSE OF
REMAINS, YOU MAY DO SO IN THE | 18 |
| FOLLOWING PARAGRAPHS.)
| 19 |
| 2. The powers granted above shall not include the following | 20 |
| powers or
shall be subject to the following rules or | 21 |
| limitations : | 22 |
| (NOTE: Here (here you may include
any specific limitations you | 23 |
| deem appropriate, such as: your own
definition of when | 24 |
| life-sustaining measures should be withheld; a direction
to | 25 |
| continue food and fluids or life-sustaining treatment in
all | 26 |
| events; or instructions to refuse
any specific types of |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| treatment that are inconsistent with your religious
beliefs or | 2 |
| unacceptable to you for any other reason, such as blood
| 3 |
| transfusion, electro-convulsive therapy, amputation, | 4 |
| psychosurgery,
voluntary admission to a mental institution, | 5 |
| etc.) :
| 6 |
| .............................................................
| 7 |
| .............................................................
| 8 |
| .............................................................
| 9 |
| .............................................................
| 10 |
| .............................................................
| 11 |
| (NOTE: The subject of life-sustaining treatment is of | 12 |
| particular importance. For your convenience in dealing with | 13 |
| that subject, some general statements concerning the | 14 |
| withholding or removal of life-sustaining treatment are set | 15 |
| forth below. If you agree with one of these statements, you may | 16 |
| initial that statement; but do not initial more than one. These | 17 |
| statements serve as guidance for your agent, who shall give | 18 |
| careful consideration to the statement you initial when | 19 |
| engaging in health care decision-making on your behalf.) (THE | 20 |
| SUBJECT OF LIFE-SUSTAINING TREATMENT IS OF PARTICULAR | 21 |
| IMPORTANCE. FOR
YOUR CONVENIENCE IN DEALING WITH THAT SUBJECT, | 22 |
| SOME GENERAL STATEMENTS
CONCERNING THE WITHHOLDING OR REMOVAL | 23 |
| OF LIFE-SUSTAINING TREATMENT ARE SET
FORTH BELOW. IF YOU AGREE | 24 |
| WITH ONE OF THESE STATEMENTS, YOU MAY
INITIAL THAT STATEMENT; | 25 |
| BUT DO NOT INITIAL MORE THAN ONE):
| 26 |
| I do not want my life to be prolonged nor do I want |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| life-sustaining
treatment to be provided or continued if my | 2 |
| agent believes the burdens of
the treatment outweigh the | 3 |
| expected benefits. I want my agent to consider
the relief of | 4 |
| suffering, the expense involved and the quality as well as
the | 5 |
| possible extension of my life in making decisions concerning
| 6 |
| life-sustaining treatment.
| 7 |
| Initialed ...........................
| 8 |
| I want my life to be prolonged and I want life-sustaining | 9 |
| treatment to be
provided or continued , unless I am in a coma | 10 |
| which my attending physician
believes to be irreversible , in | 11 |
| the opinion of my attending physician, in accordance with | 12 |
| reasonable medical
standards at the time of reference , in a | 13 |
| state of "permanent unconsciousness" or suffer from an | 14 |
| "incurable or irreversible condition" or "terminal condition", | 15 |
| as those terms are defined in Section 4-4 of the Illinois Power | 16 |
| of Attorney Act . If and when I am in any one of these states or | 17 |
| conditions, I have suffered
irreversible coma, I want | 18 |
| life-sustaining treatment to be withheld or
discontinued.
| 19 |
| Initialed ...........................
| 20 |
| I want my life to be prolonged to the greatest extent | 21 |
| possible in accordance with reasonable medical standards | 22 |
| without
regard to my condition, the chances I have for recovery | 23 |
| or the cost of the
procedures.
| 24 |
| Initialed ...........................
| 25 |
| NOTE: This power of attorney may be amended or revoked by you | 26 |
| in the manner provided in Section 4-6 of the Illinois Power of |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| Attorney Act. Your agent can act immediately, unless you | 2 |
| specify otherwise; but you cannot specify otherwise with | 3 |
| respect to your "personal representative" under subparagraph | 4 |
| D(iii).) (THIS POWER OF ATTORNEY MAY BE AMENDED OR REVOKED BY | 5 |
| YOU IN THE MANNER
PROVIDED IN SECTION 4-6 OF THE ILLINOIS | 6 |
| "POWERS OF ATTORNEY FOR HEALTH CARE
LAW" (SEE THE BACK OF THIS | 7 |
| FORM). ABSENT AMENDMENT OR
REVOCATION, THE AUTHORITY GRANTED IN | 8 |
| THIS
POWER OF ATTORNEY WILL BECOME EFFECTIVE AT THE TIME THIS | 9 |
| POWER IS SIGNED
AND WILL CONTINUE UNTIL YOUR DEATH, AND BEYOND | 10 |
| IF ANATOMICAL GIFT, AUTOPSY
OR DISPOSITION OF REMAINS IS | 11 |
| AUTHORIZED, UNLESS A LIMITATION ON THE
BEGINNING DATE OR | 12 |
| DURATION IS MADE BY INITIALING AND COMPLETING EITHER OR
BOTH OF | 13 |
| THE FOLLOWING:)
| 14 |
| 3. ( ) This power of attorney shall become effective on
| 15 |
| .............................................................
| 16 |
| .............................................................
| 17 |
| ( NOTE: Insert insert a future date or event during your | 18 |
| lifetime, such as a court
determination of your disability or a | 19 |
| written determination by your physician that you are | 20 |
| incapacitated , when you want this power to first take
effect . )
| 21 |
| (NOTE: If you do not amend or revoke this power, or if you do | 22 |
| not specify a specific ending date in paragraph 4, it will | 23 |
| remain in effect until your death; except that your agent will | 24 |
| still have the authority to donate your organs, authorize an | 25 |
| autopsy, and dispose of your remains after your death, if you | 26 |
| grant that authority to your agent.) |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| 4. ( ) This power of attorney shall terminate on
.......
| 2 |
| .............................................................
| 3 |
| ( NOTE: Insert insert a future date or event, such as a court | 4 |
| determination that you are not under a legal disability or a | 5 |
| written determination by your physician that you are not | 6 |
| incapacitated, if of your
disability, when you want this power | 7 |
| to terminate prior to your death . )
| 8 |
| (NOTE: You cannot use this form to name co-agents. If you wish | 9 |
| to name successor agents, insert the names and addresses of the | 10 |
| successors in paragraph 5.) (IF YOU WISH TO NAME SUCCESSOR | 11 |
| AGENTS, INSERT THE NAMES AND ADDRESSES OF
SUCH SUCCESSORS IN | 12 |
| THE FOLLOWING PARAGRAPH.)
| 13 |
| 5. If any agent named by me shall die, become incompetent, | 14 |
| resign,
refuse to accept the office of agent or be unavailable, | 15 |
| I name
the following (each to act alone
and successively, in | 16 |
| the order named) as successors to such agent:
| 17 |
| .............................................................
| 18 |
| .............................................................
| 19 |
| For purposes of this paragraph 5, a person shall be considered | 20 |
| to be
incompetent if and while the person is a minor , or an | 21 |
| adjudicated
incompetent or disabled person , or the person is | 22 |
| unable to give prompt and
intelligent consideration to health | 23 |
| care matters, as certified by a licensed physician.
| 24 |
| (NOTE: If you wish to, you may name your agent as guardian of | 25 |
| your person if a court decides that one should be appointed. To | 26 |
| do this, retain paragraph 6, and the court will appoint your |
|
|
|
09600HB6477ham001 |
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LRB096 21113 AJO 39174 a |
|
| 1 |
| agent if the court finds that this appointment will serve your | 2 |
| best interests and welfare. Strike out paragraph 6 if you do | 3 |
| not want your agent to act as guardian.) (IF YOU WISH TO NAME | 4 |
| YOUR AGENT AS GUARDIAN OF YOUR PERSON,
IN THE EVENT A COURT | 5 |
| DECIDES
THAT ONE SHOULD BE APPOINTED, YOU MAY, BUT ARE NOT | 6 |
| REQUIRED TO, DO SO BY
RETAINING THE FOLLOWING
PARAGRAPH. THE | 7 |
| COURT
WILL APPOINT YOUR AGENT IF THE COURT FINDS THAT SUCH
| 8 |
| APPOINTMENT WILL SERVE YOUR BEST INTERESTS AND WELFARE. STRIKE | 9 |
| OUT
PARAGRAPH 6 IF YOU DO NOT WANT YOUR AGENT TO ACT AS | 10 |
| GUARDIAN.)
| 11 |
| 6. If a guardian of my person is to be appointed, I | 12 |
| nominate the agent
acting under this power of attorney as such
| 13 |
| guardian, to serve without bond or security.
| 14 |
| 7. I am fully informed as to all the contents of this form | 15 |
| and
understand the full import of this grant of powers to my | 16 |
| agent.
| 17 |
| Dated: ..........
| 18 |
| Signed ..............................
| 19 |
| (
principal's signature or mark
principal
)
| 20 |
| The principal has had an opportunity to review read the | 21 |
| above form and has
signed the form or acknowledged his or her | 22 |
| signature or mark on the form in my presence. The undersigned | 23 |
| witness certifies that the witness is not: (a) the attending | 24 |
| physician or mental health service provider or a relative of | 25 |
| the physician or provider; (b) an owner, operator, or relative |
|
|
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| of an owner or operator of a health care facility in which the | 2 |
| principal is a patient or resident; (c) a parent, sibling, | 3 |
| 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 |
| .......................
| 9 |
| (Witness Signature)
| 10 |
| .......................
| 11 |
| (Print Witness Name)
| 12 |
| .......................
| 13 |
| (Street Address)
| 14 |
| .......................
| 15 |
| (City, State, ZIP)
| 16 |
| .......................... Residing at......................
| 17 |
| (witness)
| 18 |
| (NOTE: You may, but are not required to, request your agent and | 19 |
| successor agents to provide specimen signatures below. If you | 20 |
| include specimen signatures in this power of attorney, you must | 21 |
| complete the certification opposite the signatures of the | 22 |
| agents.) (YOU MAY, BUT ARE NOT REQUIRED TO, REQUEST YOUR AGENT | 23 |
| AND SUCCESSOR AGENTS
TO PROVIDE SPECIMEN SIGNATURES BELOW. IF | 24 |
| YOU INCLUDE SPECIMEN SIGNATURES
IN THIS POWER OF ATTORNEY, YOU | 25 |
| MUST COMPLETE THE CERTIFICATION OPPOSITE THE
SIGNATURES OF THE | 26 |
| AGENTS.)
|
|
|
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| Specimen signatures of I certify that the signatures of my
| 2 |
| agent (and successors). agent (and successors) are correct.
| 3 |
| ....................... ...................................
| 4 |
| (agent) (principal)
| 5 |
| ....................... ...................................
| 6 |
| (successor agent) (principal)
| 7 |
| ....................... ...................................
| 8 |
| (successor agent) (principal)"
| 9 |
| (NOTE: The name, address, and phone number of the person | 10 |
| preparing this form or who assisted the principal in completing | 11 |
| this form is optional.) | 12 |
| .........................
| 13 |
| (name of preparer)
| 14 |
| .........................
| 15 |
| .........................
| 16 |
| (address)
| 17 |
| .........................
| 18 |
| (phone)
| 19 |
| (c) (b) The statutory short form power of attorney for | 20 |
| health care (the
"statutory health care power") authorizes the | 21 |
| agent to make any and all
health care decisions on behalf of | 22 |
| the principal which the principal could
make if present and | 23 |
| under no disability, subject to any limitations on the
granted | 24 |
| powers that appear on the face of the form, to be exercised in | 25 |
| such
manner as the agent deems consistent with the intent and |
|
|
|
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| desires of the
principal. The agent will be under no duty to | 2 |
| exercise granted powers or
to assume control of or | 3 |
| responsibility for the principal's health care;
but when | 4 |
| granted powers are exercised, the agent will be required to use
| 5 |
| due care to act for the benefit of the principal in accordance | 6 |
| with the
terms of the statutory health care power and will be | 7 |
| liable
for negligent exercise. The agent may act in person or | 8 |
| through others
reasonably employed by the agent for that | 9 |
| purpose
but may not delegate authority to make health care | 10 |
| decisions. The agent
may sign and deliver all instruments, | 11 |
| negotiate and enter into all
agreements and do all other acts | 12 |
| reasonably necessary to implement the
exercise of the powers | 13 |
| granted to the agent. Without limiting the
generality of the | 14 |
| foregoing, the statutory health care power shall include
the | 15 |
| following powers, subject to any limitations appearing on the | 16 |
| face of the form:
| 17 |
| (1) The agent is authorized to give consent to and | 18 |
| authorize or refuse,
or to withhold or withdraw consent to, | 19 |
| any and all types of medical care,
treatment or procedures | 20 |
| relating to the physical or mental health of the
principal, | 21 |
| including any medication program, surgical procedures,
| 22 |
| life-sustaining treatment or provision of food and fluids | 23 |
| for the principal.
| 24 |
| (2) The agent is authorized to admit the principal to | 25 |
| or discharge the
principal from any and all types of | 26 |
| hospitals, institutions, homes,
residential or nursing |
|
|
|
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| 1 |
| facilities, treatment centers and other health care
| 2 |
| institutions providing personal care or treatment for any | 3 |
| type of physical
or mental condition. The agent shall have | 4 |
| the same right to visit the
principal in the hospital or | 5 |
| other institution as is granted to a spouse or
adult child | 6 |
| of the principal, any rule of the institution to the | 7 |
| contrary
notwithstanding.
| 8 |
| (3) The agent is authorized to contract for any and all | 9 |
| types of health
care services and facilities in the name of | 10 |
| and on behalf of the principal
and to bind the principal to | 11 |
| pay for all such services and facilities,
and to have and | 12 |
| exercise those powers over the principal's property as are
| 13 |
| authorized under the statutory property power, to the | 14 |
| extent the agent
deems necessary to pay health care costs; | 15 |
| and
the agent shall not be personally liable for any | 16 |
| services or care contracted
for on behalf of the principal.
| 17 |
| (4) At the principal's expense and subject to | 18 |
| reasonable rules of the
health care provider to prevent | 19 |
| disruption of the principal's health care,
the agent shall | 20 |
| have the same right the principal has to examine and copy
| 21 |
| and consent to disclosure of all the principal's medical | 22 |
| records that the agent deems
relevant to the exercise of | 23 |
| the agent's powers, whether the records
relate to mental | 24 |
| health or any other medical condition and whether they are | 25 |
| in
the possession of or maintained by any physician, | 26 |
| psychiatrist,
psychologist, therapist, hospital, nursing |
|
|
|
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LRB096 21113 AJO 39174 a |
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| 1 |
| home or other health care
provider.
| 2 |
| (5) The agent is authorized: to direct that an autopsy | 3 |
| be made pursuant
to Section 2 of "An Act in relation to | 4 |
| autopsy of dead bodies", approved
August 13, 1965, | 5 |
| including all amendments;
to make a disposition of any
part | 6 |
| or all of the principal's body pursuant to the Illinois | 7 |
| Anatomical Gift
Act, as now or hereafter amended; and to | 8 |
| direct the disposition of the
principal's remains.
| 9 |
| (Source: P.A. 93-794, eff. 7-22-04.)
| 10 |
| (755 ILCS 45/4-12) (from Ch. 110 1/2, par. 804-12)
| 11 |
| Sec. 4-12. Saving clause. This Act does not in any way
| 12 |
| invalidate any health care agency executed or any act of any
| 13 |
| agent done, or affect any claim, right or
remedy that accrued, | 14 |
| prior to September 22, 1987.
| 15 |
| This amendatory Act of the 96th General Assembly does not | 16 |
| in any way invalidate any health care agency executed or any | 17 |
| act of any agent done, or affect any claim, right, or remedy | 18 |
| that accrued, prior to the effective date of this amendatory | 19 |
| Act of the 96th General Assembly. | 20 |
| (Source: P.A. 86-736.)
| 21 |
| (755 ILCS 45/2-7.5 rep.) | 22 |
| Section 10. The Illinois Power of Attorney Act is amended | 23 |
| by repealing Section 2-7.5. |
|
|
|
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| 1 |
| Section 99. Effective date. This Act takes effect July 1, | 2 |
| 2011.".
|
|